A case series on ophthalmomyiasis

Urvashi Ladko Sinai Kudchadkar; Akanksha Sharma; Ugam P Sinai Usgaonkar; Aparna Naik

doi:10.4103/jcor.jcor_50_21

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Year : 2022 | Volume : 10 | Issue : 3 | Page : 124-126

A case series on ophthalmomyiasis

Urvashi Ladko Sinai Kudchadkar, Akanksha Sharma, Ugam P Sinai Usgaonkar, Aparna Naik
Department of Ophthalmology, Goa Medical College, Bambolim, Goa, India

Date of Submission	08-Apr-2021
Date of Decision	09-Oct-2021
Date of Acceptance	03-Dec-2021
Date of Web Publication	1-Dec-2022

Correspondence Address:
Urvashi Ladko Sinai Kudchadkar
House No: 741, Laxmi Niwas, Shirfod, Curchorem, Goa
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jcor.jcor_50_21

Abstract

Ophthalmomyiasis refers to an infestation of the eye, orbit, or periorbital tissue by larval stage of Diptera flies, classified as external or internal ophthalmomyiasis and orbital myiasis. Three patients having varied ocular conditions presented with ophthalmomyiasis to our outpatient department from November 2019 to February 2020. First case was histopathologically confirmed case of basal cell carcinoma of the lower lid, the second one being a case of herpes zoster ophthalmicus. Third one was a case of trauma to the upper lid. All of them presented with a history of maggots crawling from the involved area with local signs of inflammation. In all patients, manual removal of maggots with wound dressing was done daily, and they received systemic antibiotics, oral analgesics, and anti-inflammatory drugs for 10 days. Due to rarity of this condition and cluster of cases presenting within a short span of time, we bring forward a case series on ophthalmomyiasis.

Keywords: Basal cell carcinoma, herpes zoster ophthalmicus, ophthalmomyiasis, trauma

How to cite this article:
Sinai Kudchadkar UL, Sharma A, Sinai Usgaonkar UP, Naik A. A case series on ophthalmomyiasis. J Clin Ophthalmol Res 2022;10:124-6

How to cite this URL:
Sinai Kudchadkar UL, Sharma A, Sinai Usgaonkar UP, Naik A. A case series on ophthalmomyiasis. J Clin Ophthalmol Res [serial online] 2022 [cited 2023 Jan 31];10:124-6. Available from: https://www.jcor.in/text.asp?2022/10/3/124/362506

Ophthalmomyiasis is an infestation of the eye, orbit, or periorbital tissue by maggots (larval stage of Diptera flies). Ophthalmomyiasis is classified as external or internal ophthalmomyiasis and orbital myiasis.^[1] Limited superficial infestation of external ocular tissues is called external ophthalmomyiasis.^[2] When the larvae invade deeply and migrate into the vitreous and subretinal space, internal ophthalmomyiasis occurs. Orbital myiasis is a more extensive infestation involving orbital tissue and is the most serious form. In this paper, we report one case of orbital myiasis and two cases of external ophthalmomyiasis.

Case Presentation

A series of three cases of ophthalmomyiasis presented to the outpatient department from November 2019 to February 2020.

First case was an 84-year-old male with involvement of the left eye [Figure 1]. The patient had a swelling on the left lower eyelid for the last 4 years, which gradually increased over time to involve the whole eye for which no treatment was received. On examination, there was an ulcerative lesion with rolled-out edges and pigmentation on the left lower lid and the left eye was auto-eviscerated following destruction caused by the underlying disease. Histopathology of the involved tissue revealed adenoid cystic pigmented basal cell carcinoma [Figure 2].

Figure 1: Auto-eviscerated left eye, following mechanical removal of maggots

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Figure 2: Histopathology showing adenoid cystic pigmented basal cell carcinoma

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Second case was a 36-year-old female with psychiatric illness with involvement of the left upper eyelid medially extending up to the root of the nose [Figure 3]. The patient had developed multiple lesions on the left side of the forehead including the eyelid 8 days back, for which cow dung was applied as a home remedy. On examination, the patient was diagnosed to have herpes zoster ophthalmicus.

Figure 3: Involvement of left upper eyelid medially extending up to the root of the nose. Maggots crawling from the involved area. Dried cow dung patches seen over the left side of the forehead and periorbital area

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Third case was a 17-year-old school-going boy with involvement of the left periorbital area including left upper eyelid laterally [Figure 4]. The patient had a fall from bike with trauma to the left side of the face, and the wound was neglected for 8 days.

Figure 4: Involvement of the left periorbital area including left upper eyelid laterally with maggots crawling from the involved area. Superficial abrasions over forehead due to fall

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There was no history of pet contact in all three cases.

All of them presented with a history of maggots crawling from the involved area with local signs of inflammation and conjunctivitis, as seen in [Figure 2] and [Figure 3]. On general examination, patients did not have clinical manifestations of skin diseases such as scabies and pediculosis which can occur concomitantly in such cases.

Computed tomgraphy scan showed intact bony landmarks in cases 2 and 3; however, in case 1, there was intraconal extension, de-ossification of the lamina papyracea with extension into adjacent ethmoidal air cells and left frontal sinus.

Necrotic tissue was debrided, and maggots were removed mechanically under local anesthesia. Initial dressing of the wound with turpentine followed by betadine dressing was done twice daily. All patients received systemic antibiotics (intravenous [IV] cefotaxime 1 g 12 hourly and IV metronidazole 1 pint 8 hourly) depending upon the culture sensitivity report, oral analgesics, and anti-inflammatory drugs for 10 days. The average stay in the hospital was 3 weeks. Healing of the wound with healthy granulation tissue was noted. In case 1, exenteration of orbit was advised.

Discussion

Myiasis is an infestation of the tissues caused by fly larvae (Diptera).^[3] The disease occurs when the female fly lays eggs. Larvae hatching from the ova pass into adjacent tissues and produce symptoms. Advanced age and rural background are common risk factors.^[1] It is seen in individuals with poor personal hygiene, those with damage to ocular/periorbital mucosal barrier due to trauma/surgery/ulcers/skin carcinomas such as basal or squamous cell carcinoma, and those with neurological and metabolic disorders (such as diabetes mellitus). It is more prevalent in tropical and subtropical regions due to humid environment. The most common presentation of ocular myiasis is external ophthalmomyiasis, a condition which presents with conjunctivitis-like symptoms.^[4] Orbital myiasis is the least common form,^[5] with only a few cases reported. Once established, orbital myiasis progresses rapidly and can completely destroy the orbital tissues within days.^[4] Management of orbital myiasis ranges from simple manual removal of the maggots to destructive surgeries of the globe and orbit.^[6] Successful treatment of ophthalmomyiasis with ivermectin has been reported;^[7] however, it was not used in our patients. Four cases of ophthalmomyiasis were reported in our department from November 2019 to February 2020. One was excluded from the case series as it has already been reported.^[8] On reviewing the data of past 5 years, Department of ENT had reported 42 cases of maggots' infestation, Department of Surgery had reported 37 cases, and only 1 case of ophthalmomyiasis was reported in the Department of Ophthalmology in Goa Medical College. On reviewing literature, no definitive reason was found as to why ophthalmomyiasis is less common. Thus, four cases presenting in the span of 4 months were significant, and hence, we present this case series. In case 1, orbital myiasis occurred due to basal cell carcinoma of the lower lid. In case 2, psychiatric illness, associated viral disease and improper treatment, leads to myiasis, and in case 3, it was due to untreated periocular trauma. All these factors including poor personal hygiene, low socioeconomic status, poor knowledge of the condition and humid climate contributed to myiasis in above cases.

Conclusion

Ocular myiasis is uncommon. However, when an infestation occurs, it is usually associated with previous lesions, with precarious health conditions, and often with a rural environment that favors contact with these parasites. Although there is no absolute method for protection against myiasis, prevention could consist of practicing adequate personal hygiene, proper care of wounds, and treatment of debilitating underlying conditions.^[4]

^{Declaration of patient consent}

^{The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.}

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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