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ARTICLES
Year : 1978  |  Volume : 26  |  Issue : 1  |  Page : 51-53

Larval conjunctivitis


Department of Ophthalmology, Medical College, Amritsar, India

Correspondence Address:
Daljit Singh
Department of Ophthalmology, Medical College, Amritsar
India
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Source of Support: None, Conflict of Interest: None


PMID: 711280

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How to cite this article:
Singh D, Bajaj A, Singh M. Larval conjunctivitis. Indian J Ophthalmol 1978;26:51-3

How to cite this URL:
Singh D, Bajaj A, Singh M. Larval conjunctivitis. Indian J Ophthalmol [serial online] 1978 [cited 2024 Mar 19];26:51-3. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1978/26/1/51/31460

Infection and infestation by insect larvae is a rarity in the Western countries but is common in tropical regions where the standard of living and the level of hygiene is poor. Ocular my­iasis may assume clinical conditions of varying severity ranging from simple irritation to com­plete destruction of the orbit. The first case from India was reported by Elliot[1]. Subsequent cases were reported by Mathur and Makhija[6] Sivaramasubramaniam and Sadanand[7] and Gupta and Nema[3]. Destructive orbital myiasis was present in all these cases.

Larval conjunctivitis without any destruc­tion of the tissues has been reported by Kaljevic and Maksimovic[5] and Freney and Fox[2]. These cases were caused by the larvae of Oestrus ovis. Guzmann[4] reported a case of larval conjunctivi­tis complicated by marginal corneal ulcers.

Reported here is a case of bilateral severe larval conjunctivitis complicated by marginal corneal ulcers.


  Case Report Top


K., 7 years old female child belonging to a very poor family was admitted as an emergency with the complaints of intense pain and water­ing from both the eyes, of 24 hours duration. Ten days earlier she had an attack of measles. It being the harvesting season, the labouring parents were very busy. As a result the child remained totally neglected. She had high fever with vomiting and therefore became very weak. On the morning of admission her parents noticed long white worms moving in and out of the eyes.

On examination the child was writhing because of pain and irritation in the eyes. She was anemic, marasmic and dehydrated. Exami­nation of the eyes showed severe bilateral blepharospasm with profuse watering. The lids were slightly swollen. Maggots could be seen crawling in both the conjunctival sacs [Figure - 1].

4% lignocaine drops were put in both the eyes at short intervals. The maggots became partially immobile and were carefully picked up one by one with the help of forceps. A total of 23 maggots were removed, 9 from the right eye and 14 from the left eye. Thereafter thorough examination revealed diffuse bilateral conjunc­tival congestion with marginal corneal ulceration in the lower part [Figure - 2],[Figure - 3]. Rest of the ocular structures were unaffected.

The patient was treated with local atropine and antibiotics along with supportive therapy. She was discharged after one week.

Entomological examination revealed the larvae as those of Musca domestica (common house fly).


  Comments Top


This case is a grim commentary on the state of child health care as is currently available to countless children of our country.

Of the flies which cause conjunctival disease most belong to Muscid, Sarcophacoidae and Oesteroidae groups. All these flies are oviparous and lay their eggs on refuse and manure, leav­ing them there to hatch out into larvae (known as maggots). They have the appearance of small white worms. These are encountered in the conjunctiva when the eggs are deposited there, which hatch out within the conjunctival sac. In the case of Musca domestica the eggs may hatch out in 24 hours.

The incidence of larval infestation is favoured by an abundance of insect fauna in the locality, by the close association of human beings with infested animals and most important of all by having conditions of filth and squalor.

In primary ocular myiasis the earliest lesion probably occurs in the form of conjunctivitis and corneal ulceration, as seen in our case. Subsequently penetration through the cornea and the fornices results in destructive orbital myiasis. Our patient barely escaped such a terrible fate.

Ocular myiasis by the larvae of Musca domestica has not been reported earlier, inspite of the fact that the common house fly is seen in great abundance. Severe debilitation malnutri­tion, poor hygiene and neglect of the child in filthy surroundings have contributed to the larval invasion in our case.


  Summary Top


Reported here is a case of bilateral larval conjunctivitis complicated with marginal corneal ulcers. It was caused by the larvae of Musca domestica (common house fly). Timely removal of the larvae saved both the eyes.

 
  References Top

1.
Elliot, R.H., 1910, Quoted by Sivaramasubrama­niam and Sadanand, 1968, Brit. J. Ophthal. 52, 64.  Back to cited text no. 1
    
2.
Freney, C.C. and Fox, H.C., 1974, Med. J. Aust. 61,310.  Back to cited text no. 2
    
3.
Gupta, S.K. and Nema, H.V., 1970, Jour of Laryngology 84, 453.  Back to cited text no. 3
    
4.
Guzmann, 1910, Quoted by Duke Elder 1965. Sys. of Ophthal. Vol 8, part 1 p. 426. Henry Kimpton, London.  Back to cited text no. 4
    
5.
Kaljevic, V. and Maksimovic V., 1973, Acta.Ophthal. Ugosl. 11, 351.  Back to cited text no. 5
    
6.
Mathur, S.P. and Makhija, J.M., 1967, Brit. J.Ophthal. 51, 406.  Back to cited text no. 6
    
7.
Sivaramasubramaniam, P. and Sadanand, V., 1968, Brit. J. Ophthal., 52, 64.  Back to cited text no. 7
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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