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   Table of Contents      
CASE REPORT
Year : 1990  |  Volume : 38  |  Issue : 4  |  Page : 184-186

Destructive ocular myiasis in a noncompromised host


Dr. Rajendra Prasad Centre for Opthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India

Correspondence Address:
Mahipal S Sachdev
Dr. Rajendra Prasad Centre for Opthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029
India
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Source of Support: None, Conflict of Interest: None


PMID: 2086473

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  Abstract 

A case of destructive ocular myiasis resulting in complete loss of the globe in two days time is documented. To the best of our knowledge this is the first report of such a severe involvement in a healthy and non-compromised host. Mechanical removal and good local hygiene helped heal the wound. The larvae were isolated to be that of Chrysomyia bezziana (screwworm fly). This is possibly the first report of destructive ocular myiasis caused by Chrysomyia bezziana from the Indian subcontinent and the second in world literature. Infestation of human eyes with larvae of flies (myiasis) has been reported. Serious consequences of destructive myiasis are seen in emaciated and diseased patients. Only one report of total destruction of the globe by maggots of Chrysomyia bezziana exists in the literature. As in previous communications, the patient in this report had no predisposing factors both systemic and local. We here in document a case of orbital myiasis leading to rapid destruction of the globe within two days in a healthy and a non-compromised patient.


How to cite this article:
Sachdev MS, Kumar H, Roop, Jain AK, Arora R, Dada V K. Destructive ocular myiasis in a noncompromised host. Indian J Ophthalmol 1990;38:184-6

How to cite this URL:
Sachdev MS, Kumar H, Roop, Jain AK, Arora R, Dada V K. Destructive ocular myiasis in a noncompromised host. Indian J Ophthalmol [serial online] 1990 [cited 2019 Dec 6];38:184-6. Available from: http://www.ijo.in/text.asp?1990/38/4/184/25502


  Case report Top


An eighty-year old woman of urban background presented with complaints of watering in the right eye without associated redness, discharge, itch',ig or pain of four days duration. She was prescribed local antibiotic drops elsewhere which gave no relief. Two days later she developed an ulcer over the right upper lid with blood stained discharge. In addition, insects crawling in the ulcer were noticed. She did give any history of trauma, insect bite, preceeding tumour or non-healing ulcer. History of any systemic disease was absent.

The patient had lost useful vision in the right eye one year prior to this episode following endophthalmitis after lens extraction. She was treated medically and since had a non- functional but non-irritable globe.

Systemic examination conducted did not reveal any abnormality. The patient was mobile, fully conscious and well oriented in time, space and person.

On ocular examination, a large ulcer of about 6 cm X 2.5 cm was seen. The ulcer involved the tissue between the right brow and the right upper lid and extended lateral to the lateral canthus. The margins were inflamed and indurated. The ulcer was fully of freely moving maggots [Figure - 1] There was profuse blood stained foul smelling discharge. Further details of the ocular structures of the right eye could not be made out at this stage. [Figure - 1]

The left eye was aphakic and had a best corrected vision of 6/60. Fundus showed evidence of macular degenera­tion which could suitably explain the patient's vision. There was no other significant relevant findings in the left eye.

Investigations revealed a normal haemogram, blood sugar, proteins and electrolytes. Routine and micro­scopic examination of urine was also normal. Skiagrams of skull, orbit and paranasal sinuses did not show any area of bone destruction.

A diagnosis of destructive ocular myiasis of the right eye and aphakia with macular degeneration of the left eye was made.

Mechanical removal of the maggots was undertaken. Topical anesthesia was applied with 4% Xylocaine. Ether was poured over the wound to reduce the move­ments of the maggots. The maggots were removed from the ulcer bed, conjunctival sac and also the lacrimal sac area. The maggots were removed with the help of a forceps. Considerable difficulty was encountered in removal as the,maggots had buried deep into the wound and resisted removal by firmly adhering to the burrows. Addition of trupentine was then tried in order to suffocate the maggots. A total of about 70 maggots could be removed [Figure - 2] Biopsy samples were taken from the wound edges and base and sent for histopathology. The wound was then cleaned with Savlon (Chlorhexide and Cetrimide) and hydrogen peroxide. On retracting the lids it was found that the globe had been completely destroyed and no structures could be seen. The patient was started on systemic antibiotics.

On opening the dressing the next day more maggots were seen and they were also removed. Daily dressing of the wound was done. The ulcer healed well in 5 weeks time [Figure - 3][Figure - 4]

Examination of the samples from the ulcer revealed inflammatory cells with no evidence of malignancy [Figure - 4]

The maggots were examined by an entomologist and identified as screw worms i.e. larvae of the fly Chrysomyia bezziana. The identifying features included deep constrictions between the seqments of the body and the characteristic configuration of posterior spiracles [3][Figure - 5].


  Discussion Top


Ocular myiasis may assume clinical conditions of vary­ing severity at one end of the spectrum, an accidental solitary infestation giving rise to signs of irritation only and at the other end the total destruction of the orbit and its conversion into a stinking suppurating cavern filled with crawling maggots [1]. Myiasis can be seen in necrotic, chronically inflamed suppurated tissue. The faetor emanating from the ulcers and neglected traumatic and surgical wounds may induce the flies to deposit their eggs 1,2. Healthy tissue and normal healthy individuals are unlikely to exhibit myiasis.

Mechanical removal of maggots is an important step in the management of patients with miasis. The use of ether to narcotize the larvae has been reported earlier [3]. Turpentine oil has also been used in order to suffocate the maggots [4]. We were successful in the mechanical removal using these previously described modalities. All the maggots could not be removed in one sitting as they burrowed deep into the orbit. The mechanical elimination of the maggots alongwith proper hygine helped heal the wound completely in a relatively short duration of five weeks.

The maggots isolated from our case were identified as Chrysomyia bezziana because of the classical fea­tures [5]. The screw worm fly or Chrysomyia which is common in tropical Africa is also found in India. Several cases of non-ophthalmic myiasis caused by Chryso­myia have been documented from India [6],[7],[8],[9].However,no communication exists in literature from the Indian Subcontinent of ophthalmomyiasis with Chrysomyia.

Chrysomyia and Cordylobia have been described to be particularly dangerous in that the maggots have burrow­ing habits and may penetrate deep [1]. The complete destruction of the globe in two days time can therefore be explained by the known capacity of Chrysomyia to bury deep into tissues [1]. Evidence of bony destruction did not exist in our case as seen by radiological ex­amination.

Destructive ocular myiasis is almost exclusively found in debilitated and emaciated patients [1]. A rural back­ground, crowded conditions and poor personel hygiene are other predisposing factors [1]. In the only previous report available in literature of ophthalmomyiasis with Chrysomyia bezziana, total destruction of the globe was observed in a 65 year old male [2]. The patient had suf­fered a series of strokes with residual neurological deficit and a significantly diminished mental status. In addition, a preceeding predisposition in the form of ocular inflam­mation was also present [2]. In contrast, our patient, though old did not have any predisposing debilitating systemic or ocular disease. The reasons which led to the development of infestation of maggots are therefore unclear. Nevertheless this case highlights for the first time the possibility of destructive ocular myiasis occur­ing in a healthy and non-compromised host.

 
  References Top

1.
Duke-Elder S.Ocular Myiasis. In: Duke Elder S.ed.System of ophthalmol­ogy. London : Henry Kimpton 1977 : 8(1) :426-30.  Back to cited text no. 1
    
2.
Kersten RC. Shoukrey NM, Tabbara KF. Orbital Myiasis. Ophthalmology 1986:93: 1228-32.  Back to cited text no. 2
    
3.
Wood TR, Slight J R. Bilateral Orbital myiasis: report of a case. Arch Ophthalmol 1970: 84:692-3  Back to cited text no. 3
    
4.
Mathur SP. Makhija JM. Invasion of the orbit by maggots. Br. J. ophthalmol 1967:51:406-7.  Back to cited text no. 4
    
5.
Oldroyd H. Smith KGV. Diptera eggs and larvae of flies. In: Smith KGV. ed. Insects and other Arthropods of Medical Importance. London : British Museum(Natural History) 1973:304-17.  Back to cited text no. 5
    
6.
Bhatia ML. Dutt K.Myiasis of the tracheostomy wound. J Laryngol Otol 196 5 : 79:907-1 1 .  Back to cited text no. 6
    
7.
Sood VP, Kakar PK, Wattal BL Mylasis in Otorhinolaryngology with en­tomological aspects. J Laryngol Otol 1976: 90:393-9.  Back to cited text no. 7
    
8.
Sinton JA. Some cases of myiasis in India and Persia, with a description of the larvae causing the lesions. India J Med Res 1921 : 9:132-62.  Back to cited text no. 8
    
9.
Strickland c. A case of myiasis of a carious tooth. Indian Med Gaz 1929 : 64: 386.  Back to cited text no. 9
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]


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