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ARTICLES
Year : 1972  |  Volume : 20  |  Issue : 3  |  Page : 131-132

An intractable corneal ulcer (a case report)


Opthalmologist, 148 Advance Base Hospital, Pathologist MH Madras, India

Correspondence Address:
N Singh
Opthalmologist, 148 Advance Base Hospital, Pathologist MH Madras
India
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Source of Support: None, Conflict of Interest: None


PMID: 4668487

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How to cite this article:
Singh N, Misra M S. An intractable corneal ulcer (a case report). Indian J Ophthalmol 1972;20:131-2

How to cite this URL:
Singh N, Misra M S. An intractable corneal ulcer (a case report). Indian J Ophthalmol [serial online] 1972 [cited 2020 Aug 4];20:131-2. Available from: http://www.ijo.in/text.asp?1972/20/3/131/34655

Suppurative Keratitis or corneal ulcer is generally due to pyogenic or­ganism which invade the cornea from without, whenever the epithelium is damaged or its resistance is lowered. However-N-Gonorrhaea and C. Diph­theria are known to invade the normal epithelium as well.

Normally the intact corneal epithe­lium is resistent to the invasion of or­ganisms. Diminished resistence due to malnutrition and neuroparalytic keratitis give rise to desquamation of epithelium followed by corneal ulce­ration.

Corneal ulceration due to parasitic infestation are very rare. However parasite has been reported in the ante­rior chamber of the eye.[2],[4] The case reported below is corneal ulcer due to infection with a nematode most pro­bably of W. Bancrofti.


  Case Report Top


Hav, M. S. was admitted in MH with a history of pain, redness and watering of left eye of 1 week's dura­tion. He was getting treatment in the MI Room without much relief.

On examination-A corneal ulcer 5 mm in diameter in lower part of the left cornea with marked circumcorneal injection was seen.

Ant. Chamber-Clear.

Ocular tension-Normal.

Pupil-Reacting to light.

Vision-6/36 P.

Conjunctival swab culture and an­tibiotic sensitivity were non-contribu­tory. Total and differential leucocytic count revealed a count of 8, 700/cmm with Eosinophils 14%.

Night blood smears-Negative for microfilaria.

W. R. -Reactor.

Kahn, VDRLN-on-reactor.

Slit lamp microscopy did not reveal any parasite in the anterior chamber.

Initially the patient was treated with subconjunctival and Parenteral anti­biotics and mydriatic locally. Later on cauterisation with iodine pigment, pure carbolic acid together with sub­conjunctival injections of various an­tibiotics viz. Penicillin, Streptomycine and soframycine were of not much help.

Subsequently after a fortnight in the hospital, corneal hooding operation was performed and a course of corti­costeriod along with antibiotic and my­driatics locally was also tried without much relief.

Finally to rule out any fungal infec­tion a scraping from the ulcer was taken and studied for the presence of any fungus.

On microscopic examination a worm like coiled structure as shown in [Figure - 1] was observed. Next day another scraping from the ulcer was taken and stained by Leishman stain. This also revealed a small coiled `worm like' body with smooth round­ed ends [Figure - 2].

After this the patient was put on a course of Hetrazan along with sub­conjunctival injection of antibiotic and, thermal cautery of the ulcer was done. In two weeks time the ulcer healed completely leaving a deep cor­neal opacity.


  Discussion Top


The ulcer was due to a neumatode parasite most probably belonging to Wucheraria group. This area is ende­mic for W. Bancrofti and B. Malayi.

The parasite could not be identified correctly because of the destruction of the internal morphology due to the KOH solution in which the scraped material was put on fungal studies. The presence of a Nematode was an accidental finding.

The unstained and the stained slides, were also shown to Dr. M. Anantaraman (Retd.) Prof. of Para­sitology Madras Veterinary College Madras, whose opinion is as follows:

The material was examined unstain­ed. It appeared to have the general appearance of filariid nematode, but details of internal organisation or pa­pillary pattern could not be discerned.

From the size, it could be suggested that it might be juvenile or a preadult stage of a filariid.

Its generic identity cannot be deter­mined for lack of morphological de­tails.

But a suggestion could be made that it could be Wucheraria bancrorti, as there are earlier records of the worm in Madras. [2],[4]

It is believed (reported) that there have been further records of W. Ban­crofti in the ophthalamic hospital Madras. The possibility of its being some animal filariid cannot be exclud­ed, however.

Since the patient hails from Rajas­than, the suspicion of guinea-worm in­fection acquired therein is provoked from an epidemiological stand point. [3]

Since the individual had not served overseas the possibility of the other nematode commonly affecting the eye viz-Loaloa and onchocerciasis is ruled out. Our attempts to get further ma­terial from the scrapings failed to obtain the parasite.


  Acknowledgement Top


We are very thankful to Lt. Col. A. Nilakantan, Officer Commanding MH Madras for permitting us to use the hospital records for this case report and for guidance and encouragement. Our thanks are also due to Dr. Anan­taraman for his valuable opinion on the slide made from the scrappings of the ulcer.

 
  References Top

1.
Duke Elder "Parson's disease of the eye" Ed. 14, Churchill, London (ELBS) p. 188.  Back to cited text no. 1
    
2.
Wright R. E. "Adult Filaria (Wuch­eraria) Bancrofti in the ant. Cham­ber" Brit. J. Opth 18: (11), 646 650, 1934.  Back to cited text no. 2
    
3.
Wright R. E. "Encysted guinea worm of the orbit". Ind. Med. Gaz. 59 (-)-458-459, 1924.  Back to cited text no. 3
    
4.
Wright, R. E . , Iyer, P . V . S . , Pan­dit, C. G. "Description of an adult Filaria (Male) removed from the ant. chamber of the eye of man" Ind. J. Med. Res. 23(l), 199-203, 1935.  Back to cited text no. 4
    


    Figures

  [Figure - 1], [Figure - 2]



 

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