|Year : 1963 | Volume
| Issue : 3 | Page : 79-81
Orbital hydatid cyst
Hubli, Mysore, India
|Date of Web Publication||28-Jan-2008|
A V Huilgol
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Huilgol A V. Orbital hydatid cyst. Indian J Ophthalmol 1963;11:79-81
Hydatid disease is caused by the development in man, acting as an intermediate host, of the cystic larval form of Echinococcus Granulosus.
Geographical Incidence. It is a very rare disease in India, Egypt and in fact in all tropical countries (Dew, 1953). It is a disease which occurs commonly in countries where sheep and cattle raising is an industry and where close association between sheep, man and dog exists. The disease is prevalent in Iceland, South Australia, North Africa, Central and Northern Europe, Brazil, Argentina, Uraguay, and Newzealand. Thus it is a disease of the temperate climates of the world (Chatterjee, 1952).
Life History and Incidence. Dog is the optimum definitive host. The larval stage is passed in sheep, cattle, pig, or man which represent the intermediate hosts of the parasite. The eggs are swallowed by man, due to intimate handling of infected dogs, and reach, the stomach where their shell walls are digested and active hexacanth embryos hatch out and bore their way through the walls of the duodenum or intestines, enter the radicals of the portal vein and reach the liver. From the liver the embryos filter through the portal (first filter) and then through the pulmonary (second filter) circulations, and if they escape these filters, they may settle in one or other peripheral parts. This carriage through the vascular circulation accounts for the progressively lower incidence as the peripheral parts are reached, and for the relatively rare incidence in the eye and the orbit.
| Table|| |
The incidence of 0.7% here along with the observations of most other writers on the subject makes, a clinical diagnosis of the cyst extremely difficult and in most instances eyes have been removed under a mistaken diagnosis of absolute glaucoma (Sorsby 1958) or an intraorbital tumour.
Sverdlick (1961) claims to he the first in the world to have diagnosed an intraocular Hydatid cyst clinically before surgical intervention. Experimentally Demaria and Deve have proved that intraocular Hydatid cyst can be produced in animals by direct inoculation or by injecting the infective material in the Carotid artery.
| Case Report|| |
A girl aged about 8 years belonging to a nomadic tribe, was brought to me in March, 1958, complaining of swelling and pain of the right eye of two months duration and diminished vision in the left eye. There was a definite history of injury, due to a fall two months before.
On examination, the general build and health of the patient was quite normal for her age. The temperature, pulse and respiration were normal. There was no lymphadenopathy. Liver and spleen could not be palpated.
The right eye, which was in a highly degenerated state, could not be recognised as the eye at all. There was a large spherical swelling protruding from the orbit, measuring about 6 cms. in diameter. The upper eye lid was very tightly stretched over the upper edge of the swelling. The lower lid and the right cheek were swollen. There was some slight diffuse swelling in the right temporal region also. The swelling was a red congested mass from which there was oozing of blood. [Figure - 1] note the tray held to collect the dripping blood). The tumour was covered with slough. None of the ocular tissues could be made out. The location of the eye could only be guessed by a darkish somewhat round spot ever the upper temporal quadrant of the swelling. The dark spot was the uveal tissue, which was laid bare as the entire cornea had sloughed. The tumour was coming from the lower nasal quadrant of the orbit pushing the eye upward and outwards and completely destroying it. The feel of the mass was firm, unlike that of a cystic swelling, though it could not for certain be ascertained, because of pain and non-co-operation of the patient. The vision was completely lost in this eye.
The left eye had photophobia, watering ciliary congestion. It was thus presumed to be going into sympathetic ophthalmia. The vision in this eye could not be gauged for certain, as the child was illiterate and was incessantly crying because of the intense pain. No investigations were done because it was thought urgent to relieve the pain of the patient first.
Diagnosis-Clinically a diagnosis of a rapidly growing orbital sarcoma seemed to be the most probable one. Hence immediate surgery was resorted to.
| Treatment|| |
It was decided to do an exentration of the orbit. The patient was operated under general anaesthesia. The first incision was taken along the lower orbital margin starting at the anterior lacrimal crest. The orbicularis muscle was separated along the fibres and the septum orbital was reached. Just when the dissection by the point of the knife was being carried out, due to a slip on touching the bone, a puncture was accidentally made resulting in spurting out of fluid and the swelling reduced greatly in size. It was then realized that the whole swelling was due to a cyst and possibly a Hydatid cyst. A membranous sac greyish white in colour was taken out. The sac along with the remaining fluid was carefully preserved for histological examination. The orbit was seen to be having a thick-walled clean cavity formed by a fibrous capsule, the adventitia. The whole capsule and the remnant of the eye were then excised and the wound was closed by interrupted silk sutures. The wound healed uneventfully.
The other eye could not he properly treated as the patient did not stay long enough and has not reported since leaving the hospital. A part of the membranous sac and the fluid collected were sent to the pathologist who reported : "The cuticular and germinal layers of the cyst could be made out-compatible with the diagnosis of Hydatid cyst".
tion and confirmed by histo-pathological examination of the material removed at operation.
Literature regarding Hydatid disease in general and that of orbital, intraocular and extraocular Hydatid cysts in particular is reviewed and discussed.
| Acknowledgement|| |
I am very grateful to the Professor of Pathology, G. S. Medical College, Bombay, for examining the material sent by me.
| References|| |
Chatterjee, K. D. (1952) , Human Parasites and Parasitic Diseases, Calcutta 6, p. 666-678.
Craig, C. F., and Faust, F. C., Clinical Parasitology, Lea & Febiger, Philadelphia, 4th Edition, p. 524.
Dew, Harold R., Encyclopedia of Medical Practice, C. V. Morsby, Co., 2nd Edition, Vol. II, p. 590, 591.
(4) Duke-Elder, Sir Stewart, Text Book of Ophthalmology, Henry Kimpton, London, Vol, II, III, IV, V & VI, 1938, 1940. 1949. 1952. 1954, P. 1672. 1673 3445, 3447,4924, 5473, 5475. 6356, and 6926.
Hogan & Zimmerman, (1962), Ophthalmic Pathology, WV. B. Saunders, Co., Philadelphia, London, II Edition, P. 731.
Sorsby, Arnold, Systemic Ophthalmology Butter-worth & Co., London, 11 Edition, p. 258.
Sverdlic, Jos'e., American Journal of Ophthalmology, (1961) , 52, 981.
[Figure - 1], [Figure - 2]
[Table - 1]