Subconjunctival Dirofilariasis Presenting as Orbital Cellulitis.

Human ocular Dirofilariasis is a relatively rare, zoonotic disease, caused by a filarial nematode, Dirofilaria repens. This parasitic infestation usually presents as a subconjunctival nodule with hyperemia. The authors present a case of subconjunctival dirofilariasis in a 91-year-old gentleman, who presented with manifestations of orbital cellulitis. The live worm was surgically removed and identified to be D. repens.

Subconjunctival nodule due to Setaria equina erratic migration in a horse: First case report.

An 18-month-old Arabian-English filly resident in southwest France was referred for evaluation of a conjunctival mass in the right eye (OD). A pink, solid, and mobile nodular formation, measuring approximately 1.2 × 0.8 cm was found under the superior nasal bulbar conjunctiva during an ophthalmic examination that was otherwise normal. The mass was surgically removed using a standing procedure. Cytological examination of fine-needle aspirates from the mass revealed a mixed eosinophilic-lymphocytic inflammation. Histological examination confirmed the dense and diffuse eosinophilic-lymphocytic infiltrate of the mass, and it revealed several cross sections of a parasitic nematode. The morphometric diagnosis identified an immature form of a filarial worm, and molecular analysis of the mitochondrial cytochrome c oxydase subunit 1 (cox1) and 12S rRNA gene sequences led to further identification of the specimen as Setaria equina. Microfilaremia was not observed on fresh blood smears. There have been no signs of local recurrence after 18 months, nor any evidence of intraocular involvement. To the authors' knowledge, this is the first documented case of subconjunctival setariasis due to S equina in a horse.

In vivo confocal microscopy for detection of subconjunctival Onchocerca lupi infection in a dog.

A seven-year-old male castrated mixed-breed dog was diagnosed with bilateral subconjunctival masses. In vivo confocal microscopy facilitated visualization of Onchocerca lupi adult nematodes and their characteristic cuticular morphology. Long, thin, white nematodes were extracted during excisional biopsy. Histopathologic and parasitologic evaluation confirmed the diagnosis of O. lupi. In addition to surgical debulking of the parasitic granulomas, the dog received systemic doxycycline, prednisone, and ivermectin therapy. In vivo confocal microscopy was repeated one year after initial diagnosis, and no remaining nematodes were visible. To the authors' knowledge, this is the first report of use of in vivo confocal microscopy as a noninvasive diagnostic and monitoring tool for canine onchocerciasis.

A case report of an unusual presentation of ocular rhinosporidiosis as a conjunctival cystic mass.

Ocular involvement of rhinosporidiosis is seen in about 15% of cases and clinically appears as a freely mobile, granular, pink, fleshy sessile or pedunculated mass. The conjunctiva is the most common site of origin. A 25-year-old male presented with a painless mass in the lower part of the left eye for 6 months which was gradually progressive. Examination revealed a pedunculated mass of 15 mm x 15 mm arising from the lower palpebrae of the left eye retracting the lower lid. It appeared to be vascular with few white spots at the apex. Rest of the ocular examinations was within the normal limit. The presentations of ocular rhinosporidiosis vary. Though the conjunctival origin is very common, it may not have a classic pink fleshy appearance at all times. A vascular/cystic painless conjunctival mass should also be considered as a case of rhinosporidiosis in prone areas.

Human Ocular Dirofilariasis in Hong Kong.

PURPOSE: Human dirofilariasis is a helminthic infestation caused by filarial nematodes of the genus Dirofilaria. We report two cases of subconjunctival dirofilariasis in adult Chinese patients. CASE REPORTS: Case 1: A 57-year-old woman presented to us with 1-day history of left eye redness and migratory foreign body sensation. Physical examination showed a temporal subconjunctival motile mass in her left eye. Immediate surgical exploration showed a live nonpigmented roundworm measuring 120 mm in length with morphology compatible with Dirofilaria. It was later identified to be Dirofilaria repens by sequence analysis. Case 2: A 69-year-old woman presented with left eye redness and foreign body sensation for 2 weeks. She was treated elsewhere initially with topical antibiotics without any improvement. On slitlamp examination, a mobile subconjunctival mass was noted. Immediate surgical removal was performed under local anesthesia, revealing a live 50-mm-long worm. It was identified as Dirofilaria hongkongensis. Both patients had normal systemic workup results and remained symptom-free after surgical removal of the nematode. Clinical findings, diagnosis, pathogenesis, and management are discussed. CONCLUSIONS: Ophthalmic dirofilariasis is a rare condition. Clinicians should be aware of this disease entity so that prompt diagnosis and treatment could be offered to the patients.

Conjunctival habronemiasis in a square-lipped rhinoceros (Ceratotherium simum).

A captive female square-lipped rhinoceros born in 1993 had been showing intermittent signs of bilateral conjunctivitis and conjunctival proliferation since 1998. Periodic improvement was noted, especially in winter, but overall the condition had deteriorated over the years. Treatment with various topical, intralesional, and systemic antibiotics and glucocorticosteroids was largely ineffective, as were repeated dewormings. No primary cause for these lesions was found in biopsies taken in 2000 and 2006, although a severe infiltrate of numerous eosinophils was observed in the latter. As the condition worsened, secondary corneal changes were noted, and eventually vision was lost due to proliferative conjunctival tissue. Aggressive resection of the proliferating tissue in 2013 restored vision and submitted biopsies yielded a diagnosis of severe allergic conjunctivitis, eosinophilic granuloma, and habronematid (Habronema or Draschia) larval infection. As no other rhinoceros in the herd was affected, including two calves born to the patient who were in close contact with their mother, it was concluded the presentation was most likely due to a hypersensitivity reaction to the dead or dying larvae. Fly repellent is now regularly applied around the eye of this rhinoceros, and a protective face mask has been fitted. Ongoing periodic relapses are treated with oral ivermectin, topical antibiotics, and steroids.

External ophthalmomyiasis: a case series and review of ophthalmomyiasis in Turkey.

Ophthalmomyiasis externa is the infestation of the superficial external ocular structures by fly larvae. This is a particularly rare condition, which has nevertheless been reported in several countries worldwide. It is common in sheep-farming areas, especially in Mediterranean countries. The patients may present with classic conjunctivitis, pseudomembranous conjunctivitis, conjunctival hemorrhages, punctuate keratitis, keratouveitis, and eyelid edema with erythema. Herein, we present three cases of external ophthalmomyiasis caused by Oestrus ovis larvae and review ophthalmomyiasis cases reported from Turkey.

Ocular rhinosporidiosis mimicking conjunctival squamous papilloma in Kenya - a case report.

BACKGROUND: Ocular rhinosporidiosis is a chronic granulomatous infection caused by a newly classified organism that is neither a fungus nor bacterium. It often presents as a benign conjunctival tumour but may mimic other ocular conditions. It is most often described in India. In Africa cases have been reported from South Africa, Kenya, Tanzania, Malawi, Uganda, Congo and Ivory Coast. CASE PRESENTATION: A 54 year old man was seen in Kenya with a lesion that resembled a conjunctival papilloma. We report resemblance to conjunctival papilloma and the result of vital staining with 0.05% Toluidine Blue. CONCLUSION: Ocular rhinosporidiosis occurs in East Africa. It may resemble conjunctival squamous papilloma. Vital staining with 0.05% Toluidine blue dye did not distinguish the two lesions well.

Human oestriasis acquired in Florence and review on human myiasis in Italy.

Myiases-causing flies are widely observed in tropical countries, whereas in Italy, a temperate country, their epidemiology and clinical presentation are poorly known. We report three cases of human conjunctival myiasis recently observed at our hospital, and the results of a review of the literature on human myiasis in Italy. In August 2012, a case of Oestrus ovis conjunctival myiasis acquired in the city centre of Florence, Italy was diagnosed at our hospital. In the early fall of 2013, two additional cases, acquired in the neighbouring areas, occurred. The review of literature showed that, up to the middle of 1990s, myiasis in Italy was mainly an occupational disease of shepherds, caused by O. ovis. Recently, cases of travel acquired furuncular myiasis emerged, together with "opportunistic" autochthonous cases of wound myiasis in patients with underlying health conditions. Considering the causative agents of human of myiasis in Italy, among the 703 autochthonous cases reported, 98.1% were caused by O. ovis, while among the 42 imported cases described, 59.5% were due to Cordylobia spp. and 40.5% to Dermatobia hominis. Our findings suggest that O. ovis conjunctival myiasis may still be observed in urban setting in Italy. Health care providers should know and implement the basic rules of entomoprophylaxis for myiasis in the facilities where they are working and use these indications to educate patients and care givers in both pretravel care and geriatric outpatient settings.

Subconjunctival Dirofilaria masquerading as nodular scleritis.

A man in his late 50s presented with a gradually enlarging, painless, reddish mass on the white portion of his left eye for 2 weeks. His best-corrected visual acuity was 20/20 in both eyes. Slit-lamp examination showed a congested, nodular, elevated lesion on the temporal bulbar conjunctiva with two pustule-like elevations. Anterior segment optical coherence tomography showed a subconjunctival solid mass rather than an abscess or a cyst. Scleral deroofing was performed and a long thread-like object resembling a dead worm was identified. The worm was removed intact, and its histopathology confirmed the diagnosis of Dirofilaria Peripheral blood smear did not show any microfilariae. No recurrences or new lesions were observed during the follow-up examinations at 1 and 5 months post-surgery. This case highlights the importance of considering a parasitic aetiology in cases of nodular or infectious scleritis.

External ophthalmomyiasis: a case series.

Oestrus ovis or 'sheep botfly' causes common ophthalmomyiasis in warm climates. It is a self-limited infestation with symptoms such as foreign body sensation and/or tearing. The larvae can be observed in the conjunctiva and should be extracted with forceps. The development of larvae beyond the first stage does not occur in healthy humans, although they may penetrate the ocular globe, causing so-called internal myiasis. External ophthalmomyiasis is typical of rural areas, but it may be observed occasionally in urban environments.

[Conjonctival human myiasis by Oestrus ovis in Northern Africa]. / À propos de la myiase conjonctivale humaine à Oestrus ovis en Afrique du Nord.

Following the publication of a paper on Conjonctival human myiasis by Oestrus ovis in southern Tunisia by Anane and Ben Hssine (Bull Soc Pathol Exot (2010) 103(5):299-304), the author reminds that the discovery of this disease was made in Algeria, in 1907 by Edmond and Etienne Sergent.

A rare case report of Loa loa ocular filariasis.

PURPOSE: We report a case of ocular worm treated surgically and confirmed by microbiological identification. METHODS: A 33-year-old Swiss woman presented to the ophthalmic unit, complaining of pain and foreign body sensation in the left eye. Slit-lamp examination disclosed a subconjunctival amber -colored cord in the conjunctival fornix. Presentation, clinical and histopathologic evaluation, and treatment are described. RESULTS: At the time of surgery, an alive and still intact worm was extracted through conjunctival incision. Histopathology confirmed the presence of filariasis. CONCLUSIONS: As the flow of immigrants from endemic areas of Europe increases, ocular manifestation of loiasis is becoming more frequent and ophthalmologists need to be aware of this diagnosis.

A technique for capturing migratory periocular worms: a case series and review of literature.

PURPOSE: To describe the clinical presentation of migratory nematodes and to outline a simple strategy to ensure capture. METHODS: Retrospective case series. RESULTS: Two consecutive patients with suspected migratory nematodes were treated promptly by strategic placement of a pharmacological barrier in the forniceal conjunctiva using 1% lidocaine with epinephrine to block the routes of retreat and to immobilize the worms for controlled retrieval. Two live nematode worms, one subcutaneous dirofilaria and one subconjunctival Loa loa, were successfully removed. CONCLUSIONS: A sense of urgency is conveyed to isolate the migratory worm while it is still visible and residing in a location for easy surgical removal. The retreat of the worm to the deeper, inaccessible orbit is prevented by strategic placement of a perimeter of anesthetic.

[Conjonctival human myiasis by Oestrus ovis in southern Tunisia]. / La myiase conjonctivale humaine à Oestrus ovis dans le sud tunisien.

Conjunctival myiasis is the most frequent expression of ocular myiasis. It results from infestation of the conjunctiva by the larval form of flies. We report 11 cases of conjunctival myiasis to encourage ophthalmologists to be aware of the diagnosis of external ophthalmomyiasis, its complications, and its treatment. Most of the cases occurred amongst males during summer and autumn. Symptoms are related to the foreign body with a sudden evolution. We diagnosed this affection by direct observation of the larva on conjunctiva. The number of larvae ranged from 2 to 30. The larvae were identified as first-instars of Oestrus ovis. The treatment was performed by removal of the larvae which resulted in rapid improvement. In conclusion, early diagnosis and management are important in preventing complications of internal ophthalmomyiasis.

Recently recognized cases of ophthalmofilariasis in Hungary.

PURPOSE: To report four cases of zoonotic ophthalmodirofilariasis infection caused by Dirofilaria repens in Hungary. METHODS: Four cases of ophthalmofilariasis have been treated at our department during the last 14 months. A subconjunctival moving worm was observed by slit lamp biomicroscopy in two cases. In one of these a living filaria was surgically removed, but the other disappeared. Red eye and migrating edema were the presenting signs in two cases. A biopsy taken from the subcutaneous masses disclosed D repens. RESULTS: Histopathologic or parasitologic examination identified a female D repens in every case. Laboratory alterations were not found. Symptoms subsided after treatment. CONCLUSION: The clinical presentation of filariasis is not always straightforward, and a high index of suspicion is necessary in cases presenting with orbital or periorbital inflammation. During the past 10 years the identification of locally acquired infections by D repens has increased in Hungary.

[Subconjunctival nodule with Dirofilaria repens]. / Nodul subconjunctival cu Dirofilaria repens.

Dirofilaria repens infection, a zoonotic illness, is rarely seen in humans; it is more frequently met over the endemic areas of the Southern Europe and Sri Lanka. The authors report a case of dirofilaria conjunctivae in a 27 year old woman from Craiova; such infections are hardly to be found in our country. Our patient presented a mobile, bulbar, subconjunctival tumoral formation which was surgically removed; immature Dirofilaria repens was revealed into it. Case particularity was that the patient had not visited any of the endemic areas. Environmental changes with global warming can lead to some new unspecific diseases in our country.