Conjunctivitis in one eye: Think of ophthalmomyiasis also

RN Kothari; SJ Lakhani; RK Chhaya; DVR Kothari; R Rana; KM Patel

doi:10.4103/2347-6486.238519

CASE REPORT

Year : 2015 | Volume : 3 | Issue : 1 | Page : 37-39

Conjunctivitis in one eye: Think of ophthalmomyiasis also

RN Kothari¹, SJ Lakhani², RK Chhaya³, DVR Kothari⁴, R Rana³, KM Patel⁴
¹ Professor & HOD, Department of Ophthalmology, SBKS MI & RC, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
² Professor & HOD, Department of Microbiology, SBKS MI & RC, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
³ Assistant Professor, Department of Microbiology, SBKS MI & RC, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
⁴ Resident, Department of Ophthalmology, SBKS MI & RC, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India

Date of Web Publication

3-Aug-2018

Correspondence Address:
R N Kothari
Professor & HOD, Department of Ophthalmology, SBKS MI & RC, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-6486.238519

Abstract

External ophthalmomyiasis is a relatively rare condition caused by infestation of ocular tissue by the larva of oestrus ovis (a fly) which is a parasite of sheep and goats. Ophthalmomyiasis has been reported from all over the world, mostly from rural population. It generally presents as catarrhal symptoms in one eye and may be easily mistaken for viral conjunctivitis, foreign body in eye and chemical injury. A careful examination and physical removal of the larva offers complete relief. We present one such case of external ophthalmomyiasis.

Keywords: External ophthalmomyiasis, Oestrus ovis, Acute conjunctivitis

How to cite this article:
Kothari R N, Lakhani S J, Chhaya R K, Kothari D, Rana R, Patel K M. Conjunctivitis in one eye: Think of ophthalmomyiasis also. J Integr Health Sci 2015;3:37-9

How to cite this URL:
Kothari R N, Lakhani S J, Chhaya R K, Kothari D, Rana R, Patel K M. Conjunctivitis in one eye: Think of ophthalmomyiasis also. J Integr Health Sci [serial online] 2015 [cited 2023 Mar 28];3:37-9. Available from: https://www.jihs.in/text.asp?2015/3/1/37/238519

Introduction

Myiasis is a rare parasitic infestation of human or animal tissue by a fly larva. The common sites are skin wounds, eyes, nose, paranasal sinuses, throat and uro-genital tract.^[1] Ocular involvement is reported in 5% of all human myiasis.^[2] Cases have been reported from various parts of the world including India, mostly from rural population involved in agriculture and sheep and goat keeping.^{[4],[6],[8],[9],[10],[11]} We report a case of external ophthalmomyiasis due to Oestrus ovis from urban area of Vadodara city of Gujarat in a man who is a painter by occupation.

Case report:

A 37 year old male reported to ophthalmology OPD with complaints of foreign body sensation, redness, itching and watering from his right eye following something hitting his eye while driving a two-wheeler the previous evening. He was completely asymptomatic before that and had no history of any eye/systemic disease or any allergy. Examination revealed 6/6 vision in both eyes. His right eye showed mild lid edema, profuse lacrimation, conjunctival congestion and chemosis. On slit lamp examination approx 1-2 mm long four greyish white, oval, segmental larva with black bifurcated hooks on one end, crawling from the lower fornix towards limbus were observed. These larvae were photo-sensitive and were moving very rapidly on exposure to bright slit lamp light and on touch by cotton bud. Rest of the eye exam and the other eye were within normal limits. The larvae were removed physically with the help of a cotton bud and a plain forceps after instillation of paracaine and were sent for identification to dept of microbiology.

Laboratory examination revealed 2mm long milky white worms with spindle shaped skeleton, multiple segments and intersegmental spine bands. A pair of sharp dark brown oral hooks was attached to internal cephalo-pharyngeal skeleton and tuffs of numerous brown hooks were seen on the margins of each body segment [Figure 1]. They were identified as larvae of Oestrus ovis.^[1],[2] The patient was treated with antibiotic - steroid combination drops and was admitted for observation. He again complained of something moving in the eye in the evening. A repeat examination revealed two more larvae, one of which was coming out of a burrow in the lower fornix. They were also removed. At review next day and after 3 days patient was completely asymptomatic and the eye was normal on examination.

Figure 1: Larvae of oestrus ovis as seen under light microscope (10 x 10 zoom) inset shows 10 x 45 magnification of larva scolex.

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Discussion

Myiasis is an infestation of mammals by larvae of flies, (Myia means fly) and it is rare in humans. Flies of various genera like oestrus ovis, chrysomia, cochliomia, musca, sacrophage, gastrophilus, hypoderma, calliphora, lucilla have been reported to cause myiasis.^[1],[2] Ophthalmic myiasis is mostly caused by oestrus ovis which is a parasite of sheep and goats.^[2] However, cases due to Lucilia Sericata Meigen have also been reported.^[3]

The adult female fly swarms around the head of sheep and goats and lays larvae around the nostrils, from where they migrate to sinuses and develop. After several months the mature larvae are dropped on the ground by sneezing. In the ground they further develop to pupa stage. The adult fly emerges from the pupa in 3-6 weeks.

Occasionally, the fly accidentally strikes the human eye and ejects larvae on the ocular surface causing external ophthalmomyiasis. Man thus becomes a temporary and accidental intermediate host.^[2] These larvae are unable to survive in human eye and die within 10 days. The larvae do not have proteolytic enzymes, hence do not generally penetrate into deeper layers and present mostly as acute catarrhal conjunctivitis, foreign body sensation, lacrimation, redness, sub-conjunctival haemorrhage, itching and mild lid swelling but it may get embedded into conjunctiva.^[4] It can also cause peripheral corneal infiltration and superficial punctuate keratitis perhaps due to crawling over cornea.^[5],[6] Kerato-uveitis due to Oestrus ovis has also been reported.^[7] Ophthalmomyiasis has been reported from various parts of the world and though considered rare in India,^[8] it may not be all that uncommon and cases have been reported from all over the country.^{[4],[6],[8],[9],[10],[11]} Outbreak of cluster of cases over a very short period have also been reported from various parts of the world.^[12]

The symptoms seem to be due to foreign body effect, infection or allergic reaction to the larva. Physical removal offers complete relief from symptoms. Addition of topical steroids and antibiotics helps in taking care of any allergic reaction to the larva and prevention of secondary infection.

Similar presentation may be caused by acute conjunctivitis, conjunctival and corneal foreign bodies and chemical or physical injuries and should be considered as differential diagnosis. A very careful examination under magnification must be done in all such cases to rule out ophthalmic miasis. Mere eye irrigation and topical antibiotics will not be able to remove the larvae. Prompt physical removal with the help of a cotton bud or a forceps is essential.[13]

References

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