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Ocular Cysticercosis — A Profile
Abstract
A retrospective study was conducted on all histopathologically proven cases of ocular cysticercosis spanning a decade in a tertiary referral centre of North India. The symptomatology, presentation, complications and treatment therapies of 18 of these patients are discussed. The most common age group to be affected was 11-20 years (50%), while the most common site involved was subconjunctival (78%), followed by lid (11%). Spontaneous extrusion was documented in three cases. Medical treatment with albendazole under the cover of corticosteroids was found to be a useful adjunct to surgical excision.
... According to demographic studies, extraocular involvement has been found to be more prevalent in Asian countries and intraocular involvement in Western countries [3]. The mean duration of symptomatology was 2 months and 5 months, as described in the studies conducted by Rath et al. [3] and Chowdhary et al. [4], respectively. This case is being reported because of the unusual location and chronic presentation of cysticercosis, which masqueraded as a dermoid cyst. ...
... In a 2007 study conducted by Madigubba et al. [6], the most common location of cysticercosis was subconjunctival in 63% (74/118), intraocular in 26% (31/118), and orbitoadnexal in 11% (13/118). In 2003, in a study conducted by Chaudhary et al. [4] (Table 1), the most commonly involved site was subconjunctival (78%) (14/18) followed by one each in the orbit and vitreous cavity with a mean duration of presentation of 20 weeks (4-104 weeks). Shanbhag et al. [7] reported a case of a 24-year-old male with a firm, non-reducible, nonpulsatile swelling over the medial aspect of the right upper lid since last 12 months. ...
... The most commonly involved suture lines are the zygomatico-frontal suture in 2/3 and the fronto-ethmoidal suture in 1/3 of patients [10]. A probable reason for this unusual location in our case could be explained by the course of the ophthalmic artery, which runs along the medial side of the orbit after giving the lacrimal branches [4]. Therefore, if a possible case of periorbital cysticercosis is encountered, a high degree of clinical suspicion, along with the characteristic features on imaging studies, is required to reach the final diagnosis. ...
Introduction
Cysticercosis is a parasitic infestation caused by Taenia solium, which is a pork tape worm. Humans are the definitive host, and pigs are the intermediate host. It is more prevalent in low socioeconomic regions with poor hygiene and among populations where undercooked pork is consumed.
Case Presentation
We hereby report an uncommon site of cyst lodgment and duration of presentation in a 24-year-old male who presented with a firm, non-tender mass over the superomedial aspect of the right orbital rim, superior to the medial canthal tendon for the last 9 years. Chronic presentation and location of the mass led to the tentative diagnosis of a dermoid cyst. Hence, a CECT orbit was advised to assess the extent and attachment of the mass. Unexpectedly, a cystic lesion with hyperdense nidus, suggestive of cysticercosis, was identified. Histopathology of the excised mass confirmed the diagnosis of cysticercosis.
Conclusion
Our case emphasizes the importance of an uncommon site and chronic presentation in cases of cysticercosis.
... [1,2] However, the subconjunctival (3%-86%), orbital (7%-59%), and eyelid (0-14%) tissues may get involved in descending order. [1][2][3][4][5][6] Subconjunctival cysticercosis has been mentioned as an anterior extension of the cyst from the insertions of extraocular muscles (recti and obliques). [1,2] The extraocular cysticercosis can have a myriad of clinical presentations depending on the cyst stage, its site, size, and relation to adjacent vital ophthalmic structures. ...
... Both tuberculosis and cysticercosis are endemic in India as well as other developing nations. [1][2][3][4][5][6][7][8]22,23] Classically, total and differential leukocyte counts, Mantoux test, chest X-ray, and sputum examination for acid-fast bacilli help in establishing the diagnosis of tuberculosis and help in starting appropriate treatment. For cysticercosis, blood investigations like peripheral eosinophilia, ELISA for anticysticercal antibodies, and stool examination for cysts can be helpful but are inconclusive, if negative. ...
... [21] The management of orbital myocysticercosis is medical in >95% of cases and a few need surgical intervention for the removal of nonresponding cysts. [1][2][3][4][5][6][7][8]22,23] In either of the management strategies, residual restriction of extraocular movements in extreme gaze can be seen as the sequelae of orbital myocysticercosis. However, in the case of subconjunctival cysticercosis, the surgical management can be performed earlier at a stage when acute anterior inflammation has subsided. ...
Purpose: To study the clinical presentation, radiological features, diagnosis, and treatment response in subconjunctival and atypical orbital myocysticercosis.
Methods: Retrospective analysis of diagnosed subconjunctival and atypical (strabismus, diplopia, and blepharoptosis) orbital myocysticercosis was performed. A diagnostic criterion (2 of the 3) among clinical features, radiological findings, and treatment response was used in our study. A minimum of "post-treatment" follow-up of 12 months was observed.
Results: Thirty-five patients were included with a mean age of 16 years having male predominance (n = 22, 62.8%). All had a unilateral presentation, with 24 (68.6%) patients having subconjunctival cysticercosis, of which 22 were located in close proximity of the rectus muscle insertion. At presentation, 10 patients had diplopia, 7 had strabismus, and 6 had face turn. Pseudo Duane's and pseudo-Brown's syndrome were noted in 5 and 4 patients, respectively. Radiologically, single muscle myositis without scolex was seen in 12 (34.3%) cases. All patients first received medical treatment, and surgical intervention (cyst removal) was attempted after treatment failure. Complete resolution of symptoms was noted in 22 (after medical treatment only) and in 8 (after surgery).
Conclusion: In the majority, the subconjunctival cysticercosis is found in proximity to the rectus muscle insertion, as a part of orbital myocysticercosis. In atypical scenarios, a satisfactory response to medical treatment can be considered as diagnostic of cysticercosis.
... Cysticercosis may affect any portion of the visual pathway from the orbit to the visual cortex [11][12][13]. The most common site of involvement as per the western studies for the lesion is posterior segment [14][15][16]. In a study by "Kruger-Leite-et al" the distribution of cysts were (35%) in the sub-retinal space, (22%) in the vitreous, (22%) in subconjuctival space, (5%) in the anterior segment and (1%) in the orbit [12]. ...
... Medical therapy with albendazole and oral steroid is recommended for the extraocular muscle form and retro-orbital cysticercosis, and dramatical improvements have been reported. 1,6,7 In our patient, the cyst was present in the inferior rectus muscle of the right eye, and she responded well to systemic albendazole and steroid therapy. In conclusion, cysticercosis is a common clinical entity in India. ...
Intraocular infection by Cysticercus cellulosae larva are often found as part of a generalized systemic infestation. Reports of orbital adnexal cysticercosis are uncommon, despite the high incidence of brain and ocular involvement. With isolated infestation of extraocular muscle being exceedingly rare, we at our institute report a rare case of isolated right inferior rectus muscle cysticercosis which presented with unilateral eccentric proptosis and restriction of upgaze Del J Ophthalmol 2012;23(1):53-54.
... Medical therapy with albendazole and oral steroid is recommended for the extraocular muscle form and retro-orbital cysticercosis, and dramatical improvements have been reported. 5,8,9 In our case, the patient underwent surgical excision of the subconjunctival cyst followed by administration of oral prednisolone 1mg/kg in tapering dose along with oral albendazole 400mg started from second postoperative day for 28 days. Dramatic improvement was seen in postoperatively ( Figure 6). ...
Cysticercosis is a parasitic infestation caused by cysticercus cellulose. Ocular and adnexal cysticercosis represents 13% to 46% of systemic disease. There are different modes of presentation of ocular cysticercosis. Case: Here we report a case with the left upper eyelid ptosis. On ocular examination, there was presence of a cystic yellowish mass of size of the eye ball in the upper palpebral sub-conjunctiva along with dystropia and limitation of extraocular movements in dextroelevation. Complete surgical excision of the cyst was achieved through splitting of the left upper eyelid. There was presence of sub-conjunctival cyst along with involvement of levator palpebral superioris (LPS) and superior rectus (SR) muscle. Histopathological examination of the cyst showed features suggestive of cysticercosis. The patient was symptomatically better postoperatively. He was commenced on oral prednisolone 1mg/kg and oral albendazole 400 mg for 28 days. Conclusion: Cysticercosis should be considered in cases of inflammatory swelling of subconjunctival space especially in people with poor personal and community hygiene.
... The last report from our centre was 11 cases [12]. A few recently reported series of cases from India include 25 cases from Vellore [13], 44 from Chennai [14], 35 cases in a more recent report from Chennai [15], 18 from New Delhi [16], and 43 from Chandigarh [17]. A case of AIDS patient with subretinal cysticercosis has also been reported from Chennai [18]. ...
Ophthalmic cysticercosis (OCC) caused by Taenia solium larval infection in eye, is emerging as a far commoner disease in the tropics. There is a scarcity in serodiagnostics to aid its laboratory diagnosis; thereby management still continues to pose a serious challenge. Presently serum IgG-ELISAs were performed on 40 consecutive clinically diagnosed OCC cases. Extraocular muscle was found to be the predominant site of infection where ocular motility disorder was the major clinical presentation. ELISA using larval somatic and excretory secretory (ES) antigens was positive in 32.5% and 45% cases respectively. Anti-ES antibodies were detected more frequently in cases having extraocular cysts compared to intraocular location. Differential levels of antibodies specific to above two antigens were estimated during the course of parasite degeneration as evident from findings following treatment. These indigenous serum IgG ELISAs might be useful as an adjunct to existing tools for diagnosis of OCC with a more promising applications in post treatment follow up of extraocular form of cysticercosis in particular.
... Oththalmic involvement is seen in 13-46% of the infected patients at times leading to impaired vision or blindness (Madigubba et al., 2007). Recently there is an increased reporting of ophthalmic cysticercosis from different parts of India including South India, which indicates that ophthalmic cysticercosis, is emerging as a far commoner disease than previously considered (George et al., 1999;David and Mathai, 2000;Chowdhary et al., 2003;Sharma et al., 2003;Sundaram et al., 2004;Kaliaperumal et al., 2005;Mohan et al., 2005;Madigubba et al., 2007). ...
For the first time, presence of locally secreted specific IgA antibodies in tear specimen from human with ophthalmic cysticercosis is documented in the present study. The ELISA using Taenia solium metacestode excretory secretory (ES) antigen demonstrated a diagnostic level of IgA antibodies in tears with 100% sensitivity (6 out of 6 confirmed cases of ophthalmic cysticercosis) whereas, 25 of 34 (73.52%) clinically suspected cases were diagnosed positive. The ELISA using T. solium metacestode somatic antigen detected a diagnostic titre of IgA antibody in tears with a sensitivity of 50% (3 out of 6 confirmed cases). The specificity of the tear IgAELISA using T. solium metacestode somatic and ES antigens is observed to be 94.87% and 92.3%, respectively. Overall in tears, the ELISA using T. solium metacestode ES antigens for detection of IgA antibodies shows a higher diagnostic efficiency (93.33%) compared to that using T. solium metacestode somatic antigen (88.88%). The sensitivities of the ELISA for detection of IgA antibodies in tears is observed to be higher than that for detection of IgG antibodies in serum using either somatic or ES antigens of the parasite.
Cysticercosis is caused by Taenia solium, a cestode or tapeworm that preferentially affects the subcutaneous tissue, brain, muscle, and the eye. It is traditionally a disease of low socioeconomic regions, but large-scale population migration has made it a matter of global concern. Its ocular invasion is a potentially blinding disease. In the last two decades, there has been considerable discussion of cysticercosis; however, most comes from a limited number of case observations. Thus, to overcome this limitation, we summarize and analyse twenty years of medical literature (from 2000 to 2020) on cysticercosis in ophthalmology.
The presentation of cysticercosis is very heterogeneous both between and within countries. Several host and parasite factors are involved in this heterogeneity. Differences in the intensity of infection pressure have not been studied thus far. We have compiled data that could demonstrate that differences in infection pressure are involved in the still high prevalence of parenchymal neurocysticercosis and ocular cysticercosis in some countries (which have a stable infection pressure) and in the high proportion of extraparenchymal neurocysticercosis in others (which have had a progressive decrease in infection pressure). Therefore, the distribution of clinicoradiological forms of cysticercosis could be a marker of the intensity of infection pressure and could help to determine in which countries control programs should be a priority.
Human cysticercosis is the infestation by Cysticercus cellulosae, the larval form of Taenia solium, a tapeworm which parasites pork. When humans become accidental intermediate hosts of these larvae, various tissues can be affected including the eye. Cysticercosis has a worldwide distribution but is especially prevalent in poorer areas of Central and South America, Africa, and Asia, as well as in developed countries with high rates of immigration from endemic areas. It is considered the leading parasitic infection involving the central nervous system (CNS) and the most common tapeworm infection affecting the eye. Although it can occur at any age, younger subjects (especially those under 40) are at higher risk with no sex predilection.
Conjunctivitis is the inflammation of conjunctiva, which is manifested as vasodilatation/hyperemia, edema and exudation. Conjunctivitis may arise due to bacterial or viral infections or due to allergy or injury by chemical or physical agents. A number of chemical mediators like prostaglandins and leukotrienes derived from arachidonic acid cascade, histamine released from mast cells, and cytokines from lymphocytes, monocytes and macrophages have been implicated in the mediation of inflammatory response. Topical management of conjunctivitis involves the treatment of underlying cause and associated inflammation. The differential clinical diagnosis of bacterial and viral conjunctivitis is very difficult. Acute bacterial conjunctivitis is self-limiting, but the use of topical antibiotics improves the rate of clinical recovery. Conventionally topical corticosteroids were employed in management of inflammation but because of their tendency to raise the intraocular pressure, facilitate infection and cataract formation, they have been replaced by the safer non-steroidal anti-inflammatory drugs (NSAIDs). Current treatment modalities for allergic conjunctivitis include topical mast cell stabilizers /antihistaminic, and NSAIDs.
To describe the clinical manifestations, diagnosis, management, and outcome of orbital cysticercosis in a tertiary eye care center in Southern India.
Retrospective observational case series.
A total of 171 patients with orbital cysticercosis.
Retrospective case series involving consecutive patients with orbital cysticercosis from March 1990 to December 2001.
Clinical resolution and significant residual deficit.
The median age at presentation was 13 years (range 2-65 years), and 93 patients (54.4%) were male. The 3 main symptoms at presentation were periocular swelling (38%), proptosis (24%), and ptosis (14%) with a median duration of 2 (range 0-24) months. The 3 main signs at presentation included ocular motility restriction (64.3%), proptosis (44.4%), and diplopia (36.8%). The cyst locations in the decreasing order of frequency were anterior orbit (69%), subconjunctival space (24.6%), posterior orbit (5.8%), and the eyelid (0.6%). In all, 80.7% of patients had cysts in relation to an extraocular muscle. The superior rectus (33.3%) was the most commonly involved extraocular muscle. Contact B-scan ultrasonography was diagnostic of cysticercosis in 84.4% of patients. Orbital cysticercosis was managed medically in 158 of 166 patients. Although 149 patients received a combination of oral albendazole and prednisolone, 1 patient received oral albendazole alone, 7 patients received oral prednisolone alone, and 1 patient received oral praziquantel. Surgery was performed in 8 patients. Clinical resolution was seen in 128 of 138 patients (92.8%) at 1 month and 81 of 85 patients (95.3%) at 3 months. A significant residual deficit was present in 29 of 138 patients (21.0%) at the final follow-up and included proptosis in 7 patients, ptosis in 6 patients, ocular motility restriction in 3 patients, diplopia in 2 patients, strabismus in 2 patients, and a combination of the above in 9 patients.
Orbital cysticercosis is a common clinical condition in the developing world. It typically affects young individuals and has a wide spectrum of clinical manifestations. Both B-scan ultrasonography and computed tomography scan are useful in confirming the diagnosis. Despite resolution of cysticercosis with medical management, a significant proportion of patients may have residual functional deficits.
A nine-year-old girl presented with pain, unilateral ptosis, inflammation of the upper eyelid and restricted ocular motility. She was diagnosed to have ocular cysticercosis by magnetic resonance imaging of the orbit, which showed a well-defined ring-enhancing lesion in the superior rectus muscle of the left eye. Enzyme-linked immunosorbent assay for serum antibodies against cysticercus was positive. The patient improved dramatically on a therapeutic trial of albendazole and oral steroids. There was a history of spontaneous extrusion of the cyst five days after starting therapy. The conjunctival defect healed without any surgical intervention.
Surgical removal of extraocular cysticerci is fraught with complications. The effect of oral albendazole in such cases has been evaluated in a randomised, controlled, clinical trial. Of 24 ultrasonographically diagnosed, and ELISA positive cases of extraocular cysticerci, 12 received oral albendazole 15 mg/kg once daily for 1 month, while the 12 controls received a placebo. Marked clinical improvement was seen in all the cases in the treatment group at 4 weeks, with collapse of the cyst at 6 weeks (75%), and complete disappearance at 3 months (100%). No clinical or ultrasonographical change was noted in the control group. A trial of medical management with oral albendazole merits consideration in cases of extraocular cysticerci.
Subretinal cysticercosis was discovered in two South African Bantu-speaking blacks. A 50-year-old man had a live, mobile, subretinal cyst, 0.3 mm in diameter, at the macula of his only eye, causing retinal edema and superficial and deep hemorrhage. A 25-year-old woman had a 6-mm wide, live, mobile cyst at the posterior pole of her right eye, surrounded by retinal edema, hemorrhage, and vasculitis involving the disk. This cyst was removed intact, after division of the lateral rectus muscle and maximum rotation of the eye. Massive vitreous hemorrhage occurred despite diathermy application, and vision was lost. Localization and incision of the sclera were difficult; in retrospect, a lateral orbitotomy would have been advisable. Histology of the cyst showed typical features of the larva of Taenia solium-a single scolex with suckers and hooks-glandshaped folds in the neck and membrane of the cyst wall.
A 49-year-old Mexican male presented with a free-floating cyst in the vitreous. The cyst was removed at the time of cataract surgery and on the first postoperative day a second cyst was found in the anterior chamber. The second cyst was excised by cryoextraction 6 weeks after the initial surgery, but the eye developed an inoperable retinal detachment and phthisis bulbi. Although the diagnosis of cysticercosis was made clinically, initially, the only laboratory evidence for parasitic infection was a peripheral blood eosinophilia. The patient later developed an enlarged liver which was consistent with parasitic infection based on a liver scan. The morphology and life cycle of the parasite is described as well as suggestions for surgical removal.
We found the following results in 30 patients with intraocular cysticercosis: (1) a higher incidence in the first two decades of life compared with neurocysticercosis, (2) living cysticerci concomitant with inflammatory reactions, (3) diseases related to immune dysfunction in 17% of the cases, (4) anticysticercus antibodies in 57% of cases, (5) blindness in 81% of patients despite proper surgery, and (6) adult Taenia solium infection in a higher frequency of cases than expected for the Mexican population. We discuss these findings in light of recent and established knowledge regarding this disease.
Intraocular cysticerci are mostly located in the subretinal space or vitreous. When the fundus is obscured by exudate or hemorrhage, the diagnosis becomes very difficult with the ophthalmoscope or biomicroscope. The authors performed A- and B-scan echographic studies on 20 cases of intraocular cysticercus during February 1985 to December 1988; it was found that B-scan was very useful in diagnosing intraocular cysticercus with regard to its location and relation to surrounding tissues. Several cases with typical echograms are presented with discussions. The ultrasonic diagnoses were confirmed by surgery.
The diagnosis of cysticercosis by enzyme-linked immunosorbent assay using serum and CSF was assessed in 61 cases of confirmed cysticercosis and in controls. A very high level of specificity and sensitivity was found.
We observed and photographed intraocular cysticercosis in a 50-year-old woman. The subretinal cysticercus in the macular area produced a macular break during its passage from the subretinal space into the vitreous cavity. The parasite was removed by closed vitrectomy, but the macular break was left untreated because there was no vitreous traction to the macula. The patient ultimately developed a subretinal scar in the macular area, and visual acuity improved from hand movements to counting fingers.
A 2-year-old Haitian girl had a 1-cm cyst of the left upper lid. The cyst was excised and microscopic examination revealed a well preserved Cysticercus cellulosae. Although ocular and cutaneous cysticercosis are common, cysticereus in the lid has rarely been reported. It should be considered in the differential diagnosis of lid cysts in patients from areas where Taenia solium is prevalent.
One hundred and ten cases of general cysticercosis have been analyzed. Ocular involvement was observed in 14 cases. Ten patients presented with subconjunctival cysts. The disease was seen more commonly on the left side and near the nasal canthus. A probable explanation for this predilection has been suggested by the peculiar manner of the blood supply.
Eleven cases of ocular Cysticercus cellulosae are reported. All the cysts were removed surgically and the diagnosis was confirmed histologically. In all but two cases the cyst was subconjunctival and not intra-ocular.
A 14-year-old Hindu boy had a gradually enlarging painless mass in the left upper eyelid. The cyst was excised, and histologic examination showed it to be a case of cysticercosis of the eyelid. The presence of a solitary cyst in a vegetarian child suggests ingestion of an ovum of Taenia solium in contaminated food or water.
A 47-year-old male from India was treated for the rare condition of bilateral multifocal intraocular infestation with Cysticercus cellulosae, the larval form of Taenia solium. The intravitreous parasite in the left eye was removed via pars plana vitrectomy. A subretinal cysticercus in the right eye, which caused a rhegmatogenous retinal detachment, was removed via sclerotomy during the scleral buckling procedure. An additional peripapillary subretinal cyst could not be removed. A subconjunctival cysticercus was incidentally found and removed at the time of surgery. The patient returned to India six weeks after surgery and is doing well.
We treated two patients who had spontaneous extrusion of cysticercus cysts and subconjunctival swelling. Additionally, one patient had severe myositis and restriction of ocular movements.
The patients were prescribed oral albendazole, 15 mg/kg of body mass per day. Systemic corticosteroids were also given to the patient who had severe myositis.
Spontaneous extrusion of the cysts occurred in both patients within three to five days of starting albendazole therapy. The conjunctival defects healed without any surgical intervention. The ocular motility in the patient with myositis returned to normal.
As extrusion happened soon after the start of albendazole therapy, it is uncertain whether this therapy played any role. Additionally, it is not clear if systemic therapy must be continued in the absence of systemic and neurologic manifestations.
Cysticercosis is due to cysticercus cellulosae and was know since a long time. Human is an intermediate occasional host by ingesting accidentally eggs of tenia. In Madagascar, neurocysticercosis are predominating (55%), occular localisations are not frequent (5%) and concerned particularly vitreous humour and retina. Diagnosis relies on serology: Elisa test, then Western Blot completed with research of circulating antibody and antigen in the acqueous humor by immocapture. Anatomopathologic test permits to confirm the diagnosis. Contribution of tomodensitometry is not conclusive therapeutic is summed up to a specific and symptomatic treatment with surgical extirpation when out means allow it.
There has been a gradual change in the socio-demographic trends of ocular/adnexal cysticerosis. We present the results of a 5-year study of 33 cases of ocular/adnexal cysticercosis and compare our observations with those reported by previous authors. The male:female ratio in our study was 2:1 and maximum number of patients (45%) belonged to the age-group of 31-40 years. Seventy percent of our patients were of low socio-economic status and 70% were strictly vegetarians. The most common location of cysticerci was in the vitreous (50% of all cases); orbital cysts were present in 5% and subconjunctival cyst in 3%. Most common extraocular site for associated cysticercosis was the brain (18%): Ultrasonography proved to be an effective and economical alternative to magnetic resonance imaging and computerized tomographic scanning for the detection of cysticerci in the orbit and in eyes with hazy media.
Human cysticercosis is secondary to an infestation by cysticercus cellulosae, the larval form of Taenia solium. Cysticercosis is endemic to regions with poor sanitation. The purpose of this report is to present a large series of patients with orbital cysticercosis and to discuss the current treatment.
A retrospective chart analysis of all patients with orbital cysticercosis from an urban practice in southern India was performed. The clinical features, the results of investigations, the therapies instituted, and the outcomes realized were recorded.
Twenty patients diagnosed with orbital cysticercosis were identified (11 female and 9 male). Their ages ranged from 5 to 25 years with a mean age of 12.5 years. Nine patients manifested subconjunctival cysts. Eight were excised and 5 of these were densely adherent to the adjacent extraocular muscle (EOM). The remaining 11 patients had a cyst in a single EOM. The EOM cysts had proptosis, restricted motility, recurrent inflammation, and blepharoptosis. Two of the EOM cysts were excised surgically and four extruded spontaneously. Six patients with EOM cysts were treated medically: they all received oral corticosteroids and, additionally, five were given oral albendazole and one was given oral praziquantel.
Excisional biopsy is recommended for subconjunctival cysticercosis. Idiopathic cystic myositis can present like EOM cysticercosis, but is differentiated by resolution with corticosteroid treatment. Medical therapy in orbital cysticercosis with oral albendazole and corticosteroids can arrest recurrent inflammation and improve ocular motility.
To evaluate the efficacy of albendazole in the management of orbital myocysticercosis.
Twenty-one consecutive patients diagnosed as having orbital myocysticercosis by ultrasonography, supported by computed tomography (CT)/magnetic resonance imaging (MRI), were included in the study. All patients received oral albendazole at a dosage of 30 mg/kg for 15 days with a low-dose steroid cover (5-10 mg per day). The patients were followed on day 2 at 2 weeks, 1 month, 3 months, 6 months and 9 months, and finally at 1 year. Orbital sonography was performed at 2 weeks, 3 months, 6 months, 9 months and 1 year. CT scan was performed at 6 months and 1 year.
Orbital sonography revealed a well-defined cystic lesion with clear contents and a hyperechoic area suggestive of a scolex in all the patients. CT or MRI provided additional supportive evidence. The size of the cysts measured before treatment ranged from 6.2 to 13.4 mm (mean 11.4 mm). Medial rectus was involved in 10 cases, superior rectus in 7 cases and lateral rectus in 4 cases. Serial ultrasonography revealed a gradual reduction in the cyst size in 20 patients. A mild obscuration of the cyst wall, followed by collapse of the cyst cavity and obscuration of the scolex, were progressively seen as the cyst reduced in size. Complete resolution of the cyst was seen in all cases at 6 months. A CT scan performed at 1 year supported the ultrasonographic findings. No systemic side effects were noted.
Oral albendazole appears to be highly efficacious in the management of orbital myocysticercosis.
To compare computed tomography (CT) and B-scan ultrasonography (USG) in the diagnosis and to study the efficacy of a combination of oral albendazole and prednisolone in the management of myocysticercosis.
Retrospective, noncomparative case series.
Twenty-six consecutive patients with myocysticercosis.
Diagnostic imaging was performed by CT scan and USG in 24 and 22 patients, respectively; serial USG was obtained in 7 patients receiving treatment. All patients received oral albendazole (15 mg/kg body weight per day) and prednisolone (1.5 mg/kg body weight per day) for 4 weeks.
Presence of scolex on CT scan compared to USG and clinical response to medical therapy were the main outcome measures. Recovery was defined as complete resolution of the scolex or of the main presenting clinical feature.
Presence of scolex on CT scan (11 of 24) and USG (11 of 22) was not different (P = 1.0; chi-square test). Recovery was seen in 24 (92%) of 26 patients receiving medical treatment. On serial USG of patients receiving treatment (n = 7), cysts with scolex were seen to progress to a cyst without scolex before final resolution. Time to recovery on treatment (0.5-35 months) correlated with the duration of symptoms at presentation (correlation coefficient r = 0.56, P = 0.003, linear regression analysis), but not with positive serum enzyme-linked immunosorbent assay for anticysticercal antibodies (P = 0.57, log-rank test) or the presence of scolex (P = 0.52, log-rank test).
Treatment with a combination of oral albendazole and prednisolone is effective in the management of myocysticercosis. Imaging methods CT and USG are equally effective in identifying the cyst and the scolex; serial USG is useful in studying the temporal sequence of therapeutic response. The longer recovery time correlating with the duration of symptoms may indicate the chronicity of the inflammatory changes requiring longer time for recovery.
To study the clinical manifestations, management and outcome of cases of ocular cysticercosis in India.
Retrospective analysis of records of patients presenting to the ophthalmology clinics, with cysticercosis, during years 1990-98.
A total of 25 patients had ocular cysticercosis, during the period studied. Majority could be surgically removed without residual effects. However four patients (16%) had no useful vision left in the involved eye.
Cysticercosis is still endemic in India and contributes to preventable blindness. Improving sanitation and health awareness are the only ways to prevent this infection.
Ten cases of cysticercosis of the eye and its adnexa are recorded.
Diagnostico de cisticercosis ocular con ultrasonido
- E A Moragrega
Le cercus cellulosae chez Phomme ff chez les animaux
- F Vosgien
Gelmintosy w oftalmologii
- S J Talkovskey
- Gelmintosy W Oftalmologii
Cysticercosis of the eye
- Aun Rao
- Satyendran
- Om
- N N Sood
Orbital cysticercois
- C G Shekhar
- B N Lemke
- Cysticercois
Ocular cysticercosis — a report of 15 cases
- Mcc Reddy
- Gupta
- Sarada Vp
Intra-ocular cysticercosis — report of three cases
- P S Reddy
- D B Reddy