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CASE REPORT
Year : 1995  |  Volume : 43  |  Issue : 3  |  Page : 135-136

Freely mobile cysticercus in the anterior chamber


Departments of Ophthalmology and Medicine, ESI Hospital, Basaidarapur, New Delhi, India

Correspondence Address:
S K Manchanda
BA - 251, Tagore Garden, New Delhi 110 027
India
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Source of Support: None, Conflict of Interest: None


PMID: 8822489

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How to cite this article:
Sachdeva R, Manchanda S K, Abrol S, Wadhwa S C, Ramachandran K A. Freely mobile cysticercus in the anterior chamber. Indian J Ophthalmol 1995;43:135-6

How to cite this URL:
Sachdeva R, Manchanda S K, Abrol S, Wadhwa S C, Ramachandran K A. Freely mobile cysticercus in the anterior chamber. Indian J Ophthalmol [serial online] 1995 [cited 2020 May 27];43:135-6. Available from: http://www.ijo.in/text.asp?1995/43/3/135/25287

Cysticercosis is a clinical condition in which the human tissue is invaded by the larvae of the Taenia solium. It occurs either by eating faecally contaminated food or by internal autoinfection. Ocular involvement occurs in 46% of the infected patients.1 The presence of cysticercus in the anterior chamber of the eye is a rare occurrence.

We present a case of a 22-year-old male in whom the freely mobile, live cysticercus presented asymptomatically, in the anterior chamber of the left eye in association with asymptomatic neurocysticercosis.


  Case report Top


A 22-year-old male presented to the ophthalmology department, ESI Hospital, Basaidarapur, New Delhi, with the complaint of a white lesion in the left eye of 10 days' duration, increasing gradually in size. There was no history of diminution or obscuration of vision. There was no history of redness or pain in the eye. There was no history of ocular or systemic illness.

On examination, a live cystic swelling, globular in shape with a neck and scolex at one side, 2x2 mm in size, greyish-white in colour, was seen in the anterior chamber, below the level of the pupil [Figure - 1]. It was freely mobile, altering its shape and protruding and retracting its head from and into the body. The cyst was neither attached to the iris nor to the cornea or lens capsule. There was no conjunctival or ciliary congestion. The cornea was clear and anterior chamber showed no reaction. On posterior segment evaluation, no abnormality was detected in the retina, macula, optic disc or vitreous. The visual acuity in both eyes was 6/6.

On investigation, the haemogram was within normal range. The stools did not reveal ova or cyst. The X-ray skull and computed tomography scan of the brain were normal. On magnetic resonance imaging, the brain showed presence of multiple Cysticercus cellulosae [Figure - 2]. The enzyme-linked immunosorbant assay (ELISA) test for cysticercosis was negative.

The cyst was removed by making a 2-mm corneal incision at the 4 o'clock position. The live cyst came out by undulating movement along with some amount of aqueous. The wound was closed with one 8-0 virgin silk suture.

On histopathologic examination of the cyst, it was confirmed to be a Cysticercus cellulosae [Figure - 3]. The patient was treated with a course of praziquintal (50 mg/kg body weight, in three divided doses for 15 days) along with oral steroids (40 mg/day) and dilantin sodium (100 mg thrice daily), to prevent convulsions due to reaction. The oral steroids and dilatin sodium were started one day prior to the beginning of praziquintal therapy and were continued during its course. At the end of the praziquintal therapy, the oral steroid was tapered off. The patient complained of headache during the course of treatment.


  Discussion Top


Ocular cysticercosis is a rare clinical condition.1, 2 Presentation of live cyst in the anterior chamber is a much rarer occurrence2, 6, 7 and is associated with iridocyclitis.6, 8, 9 As a rule, the parasite is attached to the iris and only occasionally to the corneal endothelium or lens capsule.2 In this case, the Cysticercus was neither attached to the iris nor to the cornea or lens capsule and was freely mobile, altering its shape and showing protrusion and retraction of its head from the body. The iris pattern and the lens capsule were normal. There was no flare or cells in the anterior chamber. The ELISA test was negative, but the sero-negativity of this patient does not rule out the diagnosis of cysticercosis, as the antigens associated with Cysticercus do not always give rise to the immune response.1, 10 In addition, the immune mechanisms acting upon, at a particular stage, may have no observable effects, until later.10 We, therefore, are of the opinion that the absence of reaction in the anterior chamber in this case, is due to the free mobile nature of the Cysticercus, as well as the lack of immune response to the antigens of the Cysticercus at this stage.

The portal of entry of the cyst into the anterior chamber is still debatable. It can be either from the posterior ciliary arteries3, 4 or from the angle region.6 Although, on detailed fundus examination, we found no evidence of its migration from the posterior segment, we cannot assume its entry from the angle region. A small cysticercus could have migrated from the posterior segment, without leaving any sequelae. In this case, the silent ocular involvement was associated with asymptomatic neurocysticercosis[9].

 
  References Top

1.
Miriam, R Cano. Ocular cysticercosis. In: Retina, vol. II. Schachat AP, Murphy RB, Patz A, ed. St. Louis, CV Mosby Co., 1989.  Back to cited text no. 1
    
2.
Duke Elder S. System of Ophthalmology, vol. II. Diseases of the uveal tract. St. Louis, CV Mosby Co., 1966.  Back to cited text no. 2
    
3.
Aracena T, Perez-Roca F. Macular and peripheral sub retinal cysticercosis. Ann Ophthalmol 13:1265-1267, 1981.  Back to cited text no. 3
    
4.
Bartholomew RS. Subretiml cysticercosis. Am J Ophthalmol 79:670-673, 1975.  Back to cited text no. 4
    
5.
Kapoor S, Sood GC, Aurora AL, Sood M. Ocular cysticercosis. Acta ophthalmol 55:927-930, 1977.  Back to cited text no. 5
    
6.
Malik SRK, Gupta AK, Chowdhary S. Ocular cysticercoisis. Am J Ophthalmol 66:1168-1171,1968.  Back to cited text no. 6
    
7.
Sen DK, Mathur RN, Thomas A. Ocular cysticercosis in India. Br I Ophthalmol 51:630-632,1968.  Back to cited text no. 7
    
8.
Mathur RN, Abraham L. Cysticercosis of the eye. Arch Ophthalmol 67:562-563, 1962.  Back to cited text no. 8
    
9.
Gemmel MA. Immunology and regulation of cestode zoonosis. In: Immunology of Parasitic Infections, 2nd ed., Cohen S, Sadun EH, eds. London, Blackwell Scientific Publication, 1982.  Back to cited text no. 9
    


    Figures

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


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