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   Table of Contents      
ARTICLES
Year : 1979  |  Volume : 27  |  Issue : 2  |  Page : 54-58

Ocular cysticercosis in North India


Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India

Correspondence Address:
I S Jain
Postgraduate Institute of Medical Education and Research, Chandigarh-160012
India
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Source of Support: None, Conflict of Interest: None


PMID: 541034

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How to cite this article:
Jain I S, Dhir S P, Chattopadhaya P R, Kumar P. Ocular cysticercosis in North India. Indian J Ophthalmol 1979;27:54-8

How to cite this URL:
Jain I S, Dhir S P, Chattopadhaya P R, Kumar P. Ocular cysticercosis in North India. Indian J Ophthalmol [serial online] 1979 [cited 2019 Dec 14];27:54-8. Available from: http://www.ijo.in/text.asp?1979/27/2/54/31242

Parasitic invasion of the eye ball and orbit is uncommon. Among the members of the parasites, cysticercosis is the most common platyhelminth infection. The most favoured site in ocular cysticercosis is sub-retinal in wes­tern countries Bartholomew[1]. The involvement of irtraocular structures by the cysticercosis has been rare in the series reported from India Reddy et al[3] reported 2 cases of intraocular cysticercosis out of 10 cases of ocular cysticerco­sis. Sen et al[4] found involvement of intraocular structure in only one out of 11 cases of ocular cysticercosis. Similarly, Rao et a1[2] reported one case of vitreal cysticercosis out of 15 cases of ocular cysticercosis,

We report 10 cases of intraocular cysticer­cosis seen over the past five years with only one patient having intra-orbital lodgement of the cyst.


  Case Reports Top


1. MR 45 M (J 64888) was seen with the complaints of marked diminution of vision in the L.E. for the last 4 years. There was a history of consumption of pork. On examination, right eye showed few colloid bodies in the macular area. Left eye showed clear media with a disciform lesion in the macula. A cystic swelling of the size of 4 disc diameter was seen in the lower temporal quadrant. At the centre of the cyst a white translucent area was seen. The cyst changed its position on sub. sequent examination but no movement of the scolex was seen. On follow up, patient developed plastic iridocyclitis with hypopyon and eye became phthisical. Casoni's test for hydatid disease was negative. Indirect heamagglutination test for cysticercosis was 1:32. Eye was enucleated and examined histopathologically.

The cut section of the eye ball [Figure - 1] showed thickened cornea. The anterior chamber was obliterated by total peripheral and posterior synechiae. The iris and lens were pressed against the posterior surface of the cornea. The posterior segment was largely occupied by an organizing abscess beneath the detached and dis. organised retina. The choroid was thickened and there was a prechoroidal haemorrhage within which peculiar yellow grey body of the larva [Figure - 2] was seen, Microscopically the iris, ciliary body and choroid were infiltrated by chronic inflammatory cells. The retina was totally detached, disorganised and gliotic. The subretinal space was filled with large abscesses contain­ing remnants of an unidentified cestode. The purulent exudate and granulation tissue surrounding the parasite contained many eosinophils.

2. R.S. 30 M (J 65985) was seen with the complaints of cloudiness and diminution of vision in the left eye for the last 12 months. He used to take pork. On examina­tion right eye was normal. In left eye visual acuity was reduced to finger counting at 1 meter. Fundus showed oedema of the disc with a well defined cystic mass 5.6 disc diameter in size lying on the temporal side. The cyst was deep to retinal blood vessels and a scolex was seen to come out of the cyst at several occasions. There was associated retinal detachment in the lower half. Patient had a non-tender sub-cutaneous nodule over the right temple which was excised and found to be cysticer­cosis. Casoni's test was negative and stool examination revealed Giardia cyst.

8. A 25 F (818205): gave a history of epilepsy and subcutaneous nodules on all the limbs for the last 10 years. Gross diminution of vision LE 2 years. On examination RE presented a picture of papilloedema [Figure - 3] and left eye showed reduction of visual acuity to finger counting close to face and fundus revealed vitreous degeneration with an intra-retinal cyst of 4-5 disc diameters with shiny crystals. There was an opalescent mass in the cyst. There was associated retinal detach­ment in the lower half of the fundus. She had a high eosinophilic count 2,200 per cm,m. CSF showed indirect haemagglutination, against cysticercosis, titre of 1: 128. Biopsy of the sub-cutaneous nodule revealed cysticer­cosis. She used to consume pork.

4. AS 32 M. came with complaints of sudden painless diminution of vision from the right eye 3 months ago. He used to consume pork in the past. On examination left eye was normal. Vision in right eye was reduced to finger counting 1/2 metre. In fundus a cystic mass was seen with well defined border, 4 disc diameter in size lying in the lower nasal, quadrant. Retinal vessels could be traced over the mass. At the lower border of the cyst a scolex could be seen coming out and moving about in various directions. Macular area showed a patch of chorio-retinitis with exudation and ill defined borders. Casoni's test was negative and indirect haemagglutination test for cysticercosis was 1: 512. Gradually the media became hazy in this patient.

5. BS 22 (J 59638) was referred to this hospital with complaints of diminution of vision in the right eye for last 25 days. He gave a history of consuming pork. On examination left eye was normal. In right eye visual acuity was reduced to 6/36. Fundus examination revealed a hyperaemic disc with a cystic mass 3/4 disc diameters in size lying at 6'O'clock position, 3 disc dia­meters away from the disc. At the centre of the mass was seen a grey white area with a few white shining spots. Retinal oedema was seen around the cyst and in the macular area. [Figure - 4].

IHA for cysticercosis gave a titre of 1: 8.

6. T.S. 11 Male boy (E 57058) was seen with the complaints of redness, pain and defective vision in the right eye for 7 days. There was a history of taking pork. On examination left eye was normal. Visual acuity in the right eye was reduced to 6/24 There was circum.corneal congestion and pupil was dilated (atropinised). Few cells were seen in the anterior chamber, no keratic precipitates. Vitreous had marked flare and cells. A 4-5 disc diameter mass was seen in the lower temporal quadrant through the hazy vitreous. The mass was deeper to retinal blood vessels and was found to change its position on subsequent examination, Casoni's test was negative, An attempt to evacuate the fluid from the cyst was unsuccessful. Gradually eye became soft and vision was reduced to hand movements.

7. GK 26 F was seen with complaints of occasional fits and headache, subcutaneous nodules over the forehead with protrusion of the eyeballs and gradual progressive loss of vision in both eyes for the last 4 months. There was a history of taking pork. Ocular examination revealed bilateral axial proptosis, reduction of visual acuity to finger counting 2 meters B E. There was bilateral advanced papilloedema with macular involvement. A mobile cystic mass was seen at 11`0' clock position on subsequent examination in LE. Biopsy of the subcutaneous nodule over the forehead revealed cysticercosis. IHA cysticercosis was 1: 512,

8. BS: 20 M (E 65666) was seen with the complaints of blurring of vision from left eye for the last 7 days and poor vision for the last 3 days. He had passed adult worm in the stools 4 days ago. Fundus examination revealed a cystic lesion in the macula with well defined margins and sling surface. No haemorrhage was seen. The cyst was translucent and lying behind the retina, Retinal blood vessels were coursing normally over the cyst. Serology for cysticercosis was not carried out.

9. LK, 16 F. (J 82711) presented to us with complaints of recurrent redness, diminution of vision in LE of the duration of one year with large, moving circular spot in front of LE was treated outside by ophthalmologists by S/C Decadron Tab. Tanderil, Bentnesol eye crops which gave temporary relief. RE was normal. Examination of LE revealed marked circum corneal congestion, corneal oedema, medium size KP's, hypopyon, vascularized nodules of iris and, a mobile clear cyst in the retrolental space with scolex in lower part. Pupillary reaction to light was very brisk and other details of fundus were not visible because of hazy vitreous.

ESR: 22 mm, stool showed cysts of E. Histolytica and eggs of Ankylostoma duodenale.

No Taenia could be seen.

Serology for cysticercosis not significant. She was put on oral prednisolone and S/C wymesone.

The vitreous cleared slightly, eye became quiet but fundus details were not visible.

10. D.S. 16 M (X 84276) was referred from Neurology for ocular examination. He had right facial and abducant palsy with hemiplegia and history of passing adult worm in stools. On ocular examination, visual acuity was 6/9 both eyes. There was right con­vergent squint 15°sub. He had right facial and right abducent palsy. Ophthalmoscopic examination revealed bilateral papilloedema. In addition, right eye showed a large 2-3 disc diameter clear sub-retinal cyst lying superior and temporal to the optic dic along the superior temporal vessels. The cyst had well defined margins and a white central scolex.


  Discussion Top


Most of the cases of ocular cysticercosis reported from India have been from southern part of the country. The occurence of ocular cysticercosis is not rare in Chandigarh as is evident from the occurence of over 10 cases at this Institute over the last five years. Of the ten cases only one patient had an intra-orbital lodgement of the parasitic cyst where as all the ten had intra-ocular lodgement of the parasite. This experience is quite contrary to the reports from southern India. Reddy et al[3] reported 2 cases of intraocular cysticercosis out of 10 cases of ocular cysticercosis. Sen et a1[4] fcund involve­ment of intraocular structure in only one out of 11 cases of ocular cysticercosis. Similarly, Rao et a1[2] reported one case of vitreal cysticercosis out of 15 cases of ocular cysticercosis. It appears that intraocular lodgement of the cyst is the commonest manifestation of ocular cys­tercosis in the North India whereas it is an uncommon site of lodgement in the South India. It is of interest to note that Bartholomew[1], found sub-retinal lodgement of cysticercosis as the most favoured site in Western countries. This might be due to the prevalence of different types of platyhelminths in these areas or environ­mental factor. The one eye in this study which was subjected to histopathology failed to show any hooklets. The parasite at best could be identified as a cestode.

Three of the ten patients had additional cerebral lodgement of the parasitic cysts. All the three had papilloedema. Two had epileptic fits and one had hemiplegia with multiple cranial nerve palsies. Cerebral cysticercosis is not uncommon in Chandigarh areas. Public health measures are indicated for eradication of this disease from this area.

Though history of consumption of pork is not essential for the diagnosis of cysticercosis but in this series all the patients had consumed pork at one time or the other. Only two patients gave history of passing adult worms in the stools. Indirect haemagglutination test for cysticercosis antibodies in the patients blood was positive in four out of the six patients studied. However, the diagnosis was chiefly clinical on the basis of presence of a cyst with a white transparent mobile scolex.

Parasitic uveitis due to intraocular cysticerco­sis is not uncommon. Three cases in the present series developed uveitis. Several cases previously diagnosed as cysticercosis developed iridocyclitis on follow up.


  Summary Top


Ten cases of intraocular cysticercosis are reported. Contrary to the reports from South­ern India, intraocular lodgement of the parasite was found to be the commonest site in North India. This might be due to the prevalence of different type of platyhelminths in the area or the climatic and environmental factor. Parasitic uveitis was frequently noted in several cases of intraocular cysticercosis on follow up. One eyeball that was examined histopathologically showed a parasite at best identified as cestode. Cysticercosis infestation is not uncommon in Chandigarh area. Public health measures are indicated for eradication of this disease from the area.


  Acknowledgement Top


Histopathology of the eyeball, courtesy of Armed Forces Institute of Pathology, Washing­ton, D.C. USA.

 
  References Top

1.
Bartholomew, R.S. (1275, Amer. Jour. Of Ophthal., 79, 670-673.  Back to cited text no. 1
    
2.
Rao, A.V.N., Satyandran, O. M and Shiva Reddy 1967 Orient. Arch. of Ophthal., 6, 249. 255.  Back to cited text no. 2
    
3.
Reddy, P.S. and Sateyandran, O.M, 1964 Amer. Jour. of Ophthal., 57, 664-666.  Back to cited text no. 3
    
4.
Sen, D.K., Mathur, R.N. and Thomas, A., 1967 Brit. J. of Ophthal., 51, 630, 1967.  Back to cited text no. 4
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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