|Year : 1972 | Volume
| Issue : 3 | Page : 131-132
An intractable corneal ulcer (a case report)
N Singh, MS Misra
Opthalmologist, 148 Advance Base Hospital, Pathologist MH Madras, India
Opthalmologist, 148 Advance Base Hospital, Pathologist MH Madras
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh N, Misra M S. An intractable corneal ulcer (a case report). Indian J Ophthalmol 1972;20:131-2
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., The case reported below is corneal ulcer due to infection with a nematode most probably of W. Bancrofti.
| Case Report|| |
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.
Pupil-Reacting to light.
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.
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|| |
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. ,
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. 
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|| |
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|| |
Duke Elder "Parson's disease of the eye" Ed. 14, Churchill, London (ELBS) p. 188.
Wright R. E. "Adult Filaria (Wucheraria) Bancrofti in the ant. Chamber" Brit. J. Opth 18: (11), 646 650, 1934.
Wright R. E. "Encysted guinea worm of the orbit". Ind. Med. Gaz. 59 (-)-458-459, 1924.
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.
[Figure - 1], [Figure - 2]