Clinical characteristics of Demodex-associated recurrent hordeola: an observational, comparative study.

Our study evaluated the association between Demodex infestation and recurrent hordeola and examined the clinical features associated with these eyelid lesions. This was an observational, comparative study. We reviewed 250 patients and divided them into the recurrent hordeolum (n = 153) and control (n = 97) groups. Demodex infestation was detected by epilating eyelashes around the lesion/s and viewing them under a light microscope. Patient medical records and photographs were retrospectively analyzed to identify the clinical characteristics of Demodex-associated recurrent hordeola. Demodex was detected in 91 (59.5%) and 17 (17.5%) patients in the recurrent hordeolum and control groups (p < 0.001), respectively. In the recurrent hordeolum group, Demodex mites were found in 74 (68.5%) and 17 (37.8%) of the adult and pediatric patients (p < 0.001), respectively. Among patients with recurrent hordeola, patients in their 20s were most likely to have concomitant Demodex infestation. Patients with Demodex infestations were also more likely to develop recurrent lesions within a shorter period of time from the primary incision and curettage. The most common presentation of Demodex-associated recurrent lesions was external hordeola (67%) (p = 0.002). Demodex infestation may cause recurrent hordeola in adults and children. These mites may play a greater role in the development of lesions in adult patients. The strongest association between Demodex infestation and recurrent lesions was seen in patients in their 20s. Our results suggest that if the hordeola recur within a short period of time with the clinical characteristics of external location of eyelid, multiple numbers of lesions, or anterior blepharitis, eyelash epilation should be performed to identify the presence of Demodex mites.

The first case of periorbital human dirofilariasis in the Czech Republic.

Dirofilaria repens and Dirofilaria immitis are the most common filarial species affecting humans in Europe. Dirofilaria repens causes subcutaneous or ocular infection, whereas D. immitis is responsible mainly for the pulmonary form. In this report, we present the first human case of periorbital dirofilariasis in the Czech Republic. A 58-year-old woman suffered from an eyelid oedema, redness and pain in the left eye. After excising the parasite from her eyelid, all clinical symptoms disappeared. Based on the morphology and cytochrome oxidase I sequencing, the parasite was identified as D. repens. Histology revealed that the excised worm was female with absent microfilariae in uteri. With respect to the length of the incubation period and the sequence identity with a known Czech isolate, we concluded that D. repens was most likely of autochthonous origin.

Subretinal Cysticercosis in a Challenging Case: A Case Report.

Ocular cysticercosis occurs rarely and may involve various parts of the eye including subretinal space. We report a case of a 42 years-old female with diminution of vision in the right eye for one month and no vision in the left eye for 10 years. Best corrected visual acuity in the right eye was 5/60. Fundus examination showed whitish round elevated cystic mass temporal to the macula. It was confirmed as a subretinal cyst by Brightness scan and Magnetic Resonance Imaging. The subretinal cyst was removed in toto by pars plana vitrectomy followed by histopathological examination of the cyst which confirmed the diagnosis of cysticercosis. This case report highlights the importance of early diagnosis of subretinal cysticercosis which could threaten the vision in a one-eyed patient. Pars plana vitrectomy could be an effective method for subretinal cyst removal in toto even in a challenging case.

[Disseminated cysticercosis affecting the brain, the eye and the skin on a Senegalese patient]. / Cysticercose disséminée à localisation neurologique, oculaire et cutanée chez une patiente sénégalaise.

Cysticercosis is a neglected tropical disease set as health priority by WHO. Most of the reported cases included isolated types of cysticercosis affecting the skin, the eyes or the brain . Disseminated types, however, are rare. We here report a case of disseminated cysticercosis affecting the brain, the eyes and the skin in a Senegalese female patient aged 66 years admitted with headaches and chronic seizures. Clinical examination showed cerebellar syndrome associated with generalized and painless nodular subcutaneous lesions. Diagnosis was confirmed based on histopathological examination of skin biopsy which showed cysticerci. Patient's outcome was good under albendazole therapy.

Case Report: Periorbital Filariasis Caused by Brugia malayi.

Brugia malayi is a lymphatic nematode that accounts for approximately 10% of lymphatic filariasis cases worldwide. It is endemic in several countries in South and Southeast Asia. In Thailand, B. malayi is endemic in the southern region. The extralymphatic presentation of B. malayi is rare. Here, we report the case of a woman residing in the central region of Thailand who presented with an erythematous periorbital nodule at the left medial canthal area caused by lymphatic filaria. A viable sexually mature filarial adult was removed from the lesion. The nematode species was identified as B. malayi by histology staining and DNA sequencing of the partial mitochondrial 12S ribosomal RNA (rRNA) gene. As far as we know, this is the first case report of B. malayi presenting with a periorbital nodule that has occurred in a disease non-endemic area of Thailand with possibly a zoonotic origin.

Human ophthalmomyiasis caused by Oestrus ovis-first report from Croatia and review on cases from Mediterranean countries.

Oestrus ovis is the most common cause of human ophthalmomyiasis. So far, majority of ophthalmomyiasis cases have been reported from Mediterranean countries, but not from Croatia. In current study, we present first two cases of human ophthalmomyiasis in Croatia, caused by O. ovis larvae. Reviewing a PubMed database, additional 259 cases of human ophthalmomyiasis in countries of Mediterranean basin have been reported. A total of 260 (99.62%) cases had external, while 1 (0.38%) had internal form of ocular myiasis. In all cases, O. ovis larvae were identified as the causative agent. O. ovis infestation is usually reported in shepherds and farmers although there is a high prevalence of infection in urban areas as well. Various climatic factors influence O. ovis larvipositional activity. Air temperature is the most important factor affecting O. ovis larviposition, while humidity, wind speed, and time of the day play only a moderate role. Most common symptoms of ophthalmomyiasis are irritation and redness, and in more than half of cases infestation is multiple. Ophthalmomyiasis interna is eye-compromising condition. Since there is reduced awareness among patients and medical professionals, the real number of ophthalmomyiasis cases is probably significantly higher than published. Global warming predisposes future increase of O. ovis prevalence in humans, which emphasizes the need for mandatory reporting and surveillance of disease.

Submacular cysticercosis.

Ocular cysticercosis could involve subconjunctival space, anterior chamber, extraocular muscle, subretinal space, or vitreous. The presence of intraocular live cyst is a potential threat to visual acuity. The removal of the cyst in-toto is thus of importance to prevent inflammatory reaction and ocular damage. The presence of cysticercosis underneath the macula makes the management challenging. Herein, we describe the management of a submacular live cysticercus cyst with a good postoperative gain in visual acuity. Also, the swept-source optical coherence tomography changes are described.

Clinical and Histopathological Evaluation of a Rabbit Model for Pythium insidiosum Keratitis.

Purpose: To describe the clinical characteristics and histopathological features in a rabbit model of Pythium insidiosum keratitis.Methods: Zoospores of P. insidiosum isolated from a patient with microbial keratitis were used for inoculation of the right eye of 48 New Zealand White rabbits in either low (LD) or high dose (HD). Apart from variable dosage the rabbits were grouped (6 rabbits per group) based on route of inoculation (topical on abraded cornea or intracorneal) and immunosuppression (subconjunctival steroid or no steroid). Left eye received phosphate buffered saline via route similar to the right eye. Daily clinical examination of the eye was done, the corneas were harvested on day 3, 7 and 9 and part of the cornea was preserved in 10% neutral buffered formalin for histopathological examination.Results: Left eye of all rabbits were clinically normal. Eyes with intracorneal injection of zoospores developed infection irrespective of dose of inoculation and administration of steroids. One of the consistent early signs of infection was ring like infiltrate in the peripheral cornea. On day 2, rabbits receiving HD developed significantly greater inflammation compared to LD [median clinical score in HD- 11 (IQR = 10-12), versus 9 (IQR = 8-9) in LD (p = 0.004)]. The density of inflammation showed temporal correlation (increase with time) when the inoculum was low. Of the rabbits that received topical inoculation one rabbit cornea showed mild infiltrate in steroid group while no eye was infected in the group without steroid. Sparsely septate to aseptate branching filaments were noted in the stroma of all infected corneas.Conclusions: We describe the first animal model of Pythium keratitis that holds promise for future studies. While topical inoculation of zoospores was unsuccessful in causing infection intracorneal inoculation without immunosuppression was sufficient to develop clinically severe keratitis in rabbits.

[Oestrus ovis ophthalmomyiasis at an urban area in Southern Peru]. / Oftalmomiasis por Oestrus ovis en un área urbana al sur del Perú.

Ophthalmomyiasis is the ocular infestation by dipterous larvae. It has been described in patients from rural areas, poor hygiene, or contact with animals. However, there are sporadic reports of this infestation in urban areas. We present the case of a young man without risk factors, from an urban area in southern Peru, in whom we found 10 larvae at ocular conjunctiva. The larvae were identified as Oestrus ovis, a fly that usually infests sheep and goats as part of their life cycle. We made a brief review of the case, highlighting the importance of adequately identifying the species that cause myiasis as well as its life cycle.

Ocular toxocariasis in a pediatric patient undergoing a bone marrow transplantation / Toxocariasis ocular en un paciente pediátrico sometido a trasplante de médula ósea

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Morphological characteristics of ocular toxoplasmosis and its regression pattern on swept-source optical coherence tomography angiography: a case report.

BACKGROUND: To report the successful treatment of ocular toxoplasmosis and present the use of multimodal imaging to describe the changes in ocular toxoplasmic lesions subsequent to treatment. CASE PRESENTATION: A 73-year-old female visited the clinic with decreased visual acuity in the left eye. Fundus examination showed severe vitreous haze with yellow-white infiltrates near the foveal center. Spectral-domain optical coherence tomography (SD-OCT) revealed disorganization of the retinal structure with markedly thickened choroid beneath the active lesion. Highly elevated serum titers of IgG antibodies against Toxoplasma gondii were observed. Topical and systemic steroids with oral Bactrim were administered after a diagnosis of ocular toxoplasmosis was made. After improvement in the severity of vitritis, structural en face swept-source optical coherence tomography (SS-OCT) imaging demonstrated diffuse choroidal dilation with many collateral vascular branches surrounding the active lesion. Eight intravitreal injections of clindamycin (1 mg/0.1 ml) were administered at 1- to 2-week intervals along with systemic antibiotics and steroids. After the treatment, the toxoplasmic lesion resolved to an atrophic chorioretinal scar. Dilated choroidal vessel size was normalized and collateral vascular branches were markedly constricted on structural en face SS-OCT images. CONCLUSIONS: This is the first detailed report on the morphological changes in the choroidal vasculature surrounding ocular toxoplasmic lesions that were characterized using SS-OCT-A imaging. Multimodal imaging with SS-OCT-A can be valuable in clinical diagnosis as well as in clarifying the mechanism of choroidal structural changes in ocular toxoplasmosis.

Characterisation of ocular involvement in an experimental model of neuroschistosomiasis mansoni.

The Global Burden of Disease Study 2010 listed schistosomiasis among the leading 100 causes of death in Brazil, responsible for 3.6% of the estimated total of deaths globally. Eye and adnexa are very rarely affected by schistosomiasis mansoni, with limited documentation of ocular pathology in this setting. This short communication reports ocular histolopathological findings in a murine model of neuroschistosomiasis mansoni. Lesions were found in the bulbar conjunctiva, lacrimal gland, choroid and corneoscleral limbus.

First confirmed case of bovine besnoitiosis in Rwanda.

An-eighteen months (one and half years) old heifer was presented with a progressive loss of weight leading to cachexia and was attended to by a team of doctors from the ambulatory clinic of the School of Animal Science and Veterinary Medicine, University of Rwanda. Clinical examination revealed scleroderma of both sides of the neck and pinpoint cysts in the sclera and conjunctiva as well as corneal opacity of the left eye. Histological examination of skin biopsy showed a mononuclear dermatitis with several cysts of 100-300 µm filled up with bradyzoites in the subcutis and dermis. These lesions are consistent with bovine besnoitiosis, a disease caused by Besnoitia besnoiti in cattle. To the best of our knowledge, this is the first confirmed case of bovine besnoitiosis in Rwanda.

Oftalmomiasis por Oestrus ovis en un área urbana al sur del Perú / Oestrus ovis ophthalmomyiasis at an urban area in Southern Peru

Resumen La oftalmomiasis es la infestación ocular por larvas de dípteros. Ha sido descrita en pacientes provenientes de áreas rurales, higiene deficiente o por contacto con animales. Sin embargo, existen reportes esporádicos de esta infestación en áreas urbanas. Presentamos el caso de un varón joven, sin factores de riesgo, proveniente de un área urbana al sur del Perú, que presentó 10 larvas en la conjuntiva ocular. Las larvas fueron identificadas como Oestrus ovis, una mosca que suele infestar ovejas y cabras como parte de su ciclo de vida. Realizamos una breve revisión del tema, resaltando la importancia de identificar adecuadamente la especie causante de la miasis, así como su ciclo de vida.

Ophthalmomyiasis is the ocular infestation by dipterous larvae. It has been described in patients from rural areas, poor hygiene, or contact with animals. However, there are sporadic reports of this infestation in urban areas. We present the case of a young man without risk factors, from an urban area in southern Peru, in whom we found 10 larvae at ocular conjunctiva. The larvae were identified as Oestrus ovis, a fly that usually infests sheep and goats as part of their life cycle. We made a brief review of the case, highlighting the importance of adequately identifying the species that cause myiasis as well as its life cycle.

The correlation between the microstructure of meibomian glands and ocular Demodex infestation: A retrospective case-control study in a Chinese population.

Meibomian gland dysfunction (MGD) is a common disease in ophthalmic clinic. This study aimed to explore ocular Demodex infestation on the microstructure changes of the meibomian glands (MGs) in patients with MGD by in vivo confocal microscopy (IVCM).We retrospectively reviewed 103 eyes of 52 patients with MGD and 62 eyes of 31 non-MGD patients. All enrolled patients underwent IVCM examination. The following IVCM parameters were recorded: the MG acinar density (MAD), MG acinar longest diameter (MALD), MG acinar shortest diameter (MASD), MG orifice area (MOA), severity of MG fibrosis (MF), MG acinar irregularity (MAI), meibum secretion reflectivity (MSR), inhomogeneous appearance of walls of acinar units (AWI) and periglandular interstices of acinar units (API), and the number of Demodex.The positive rate of Demodex infestation in MGDs was 89.32%, and statistically higher than control group (controls; P < .001). All parameters showed statistically significant differences between MGDs and controls (P < .001), and Demodex-negative group and Demodex-positive group (P < .05) in both MGDs and controls, except MAD (P = .826) in controls. The number of Demodex was positively correlated with MALD, MASD, MF, MAI, MSR, AWI, and API in MGDs and controls (P < .05), and negatively correlated with MAD and MOA in MGDs (P < .05). MOA showed a strong significant correlation with the number of Demodex in controls (P < .001), whereas there was no significant difference between the number of Demodex and the MAD in controls (P = .448).Demodex can cause microstructural changes of MGs, which can cause or aggravate MGD, and the more the number of Demodex infestation, the more serious the structural damage.

Clinical Features of Toxocara-Seropositive Optic Neuritis in Korea.

Purpose: This study was undertaken to analyze the characteristics of optic neuritis in Korean patients seropositive for Toxocara. Methods: We retrospectively reviewed data from patients diagnosed with optic neuritis and followed up for at least one month between 2012 and 2016. Patients were grouped according to Toxocara serological testing outcomes (positive or negative) and clinical characteristics were compared. Results: The seropositive and seronegative groups comprised 13 and 12 patients, respectively. The seropositive patients were older (56.8 years versus 34.5 years), reported ocular pain less frequently (30.8% versus 91.7%), and showed more frequent asymmetric optic disc swelling (72.7% versus 22.2%). During follow-up, visual acuity of all seronegative patients improved to 20/40 or better, compared with 38.5% of the seropositive group. Conclusion: Atypical features such as painless, older age, or asymmetric disc swelling in optic neuritis may be related to seropositivity for Toxocara, suggesting the possibility of undiagnosed Toxocara optic neuropathy.