Indian Journal of Ophthalmology

ARTICLES
Year
: 1975  |  Volume : 23  |  Issue : 3  |  Page : 28--29

Sub-conjunctival twin cysticercosis


PK Mukherjee, S Agrawal 
 Pt. J.N.M. Medical College, Raipur, M.P, India

Correspondence Address:
P K Mukherjee
Pt. J.N.M. Medical College, Raipur
India




How to cite this article:
Mukherjee P K, Agrawal S. Sub-conjunctival twin cysticercosis.Indian J Ophthalmol 1975;23:28-29


How to cite this URL:
Mukherjee P K, Agrawal S. Sub-conjunctival twin cysticercosis. Indian J Ophthalmol [serial online] 1975 [cited 2020 Apr 2 ];23:28-29
Available from: http://www.ijo.in/text.asp?1975/23/3/28/31312


Full Text

Infestation with the helminth Taenia solium or the pork-tape worm is universal. Man is usually the definitive host, but occassionally becomes an intermediate host harbouring the larval stage of the helminth, known as cysti­cercus cellulosae. The cyst shows predilection for brain and ocular structures but no organ or tissue seems to be immune.

Ocular sites commonly involved are retina, vitreous, orbit and conjunctiva. The sub con­junctival involvement is most common and in­cidence is very high as compared to western figures [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14] Prem Prakash et al pointed that out of 56 cases of sub-conjunctival cysticercosis reported from India 41 were lodged in and around the medial canthus. Patoria and Jun­narkar [8] considered conjunctiva as an uncom­mon site and reported one case.

The present report consists of two cases of sub-conjunctival cysts one of which extruded without surgery. Both the cases were in children. The most interesting feature about the cases was that each mass consisted of two cysts joined by a common isthumus.

Case No. 1

Nirmala, 8 year old Hindu girl presented herself at Dan Kalyan Singh Hospital, Raipur, M.P. with the complaints of a diffuse swelling between the limbus and the outer canthus in the left eye. The swelling was diffuse I cm x 1 cm size. There was localised con­junctival congestion over the swelling and the con­junctiva could be moved over the swelling. The swell­ing was cystic, non-reducible and non-tender. The duration was of three months and the swelling was gradually increasing in size. There was no relevant past history. Both the eyes were otherwise normal. The child was admitted for observation. In the mean time routine urine analysis, Haemogram, E.S.R., X-ray chest, Stool examination were carried out but all the results were non-contributory towards any defi­nite cause. The child was Mantoux negative. Casoni's test was negative. During the period of investigation, the swelling kept on increasing in size and moved anteriorly almost touching the limbus. It was decided to remove the growth surgically. A day before the planned surgery; it was found that a bead of pus like material was coming out from the swelling. The thick fluid could not be removed with wet swab. With little pressure on posterior edge of the swelling a translu­scent cyst came out followed by another identical cyst joined to the first with a common isthumus. There was a dense white dot at the junction of the two cysts [Figure 1]. There was hardly any bleeding. The eye was bandaged with antibiotic and the rent in the con­junctiva healed in 24 hours. Since then there was no recurrence. On histological examination the cysts proved to be that of cysticercus.

Case No. 2

P.D. a 4 year old male Hindu child was admitted in Eye ward of Dau Kalyan Singh Hospital with a diffuse red swelling in the right eye between the medial canthus and the limbus about the size of 1.5 cm x 1.5 cm. The parents noticed it about 4 months ago. The cyst started as a localised red nodule of about 1 minx 1 mm which had been gradually increasing. The child had received local corticosteroids from time to time without any relief. On examination the nodule was cystic, non-reducible and non-tender. There was localised conjunctival congestion over the cyst. The cyst was adherant to the conjunctiva as well as to the sclera.

All tests carried out in the first case were non-con­tributory in this case also.

Under general anaesthesia a thick walled cyst was removed. The cyst was adherent to the conjunc­tiva and sclera. The thick fibrous covering of the cyst was given a nick in the centre. Two cysts joined by a common stump came out [Figure 2]. It was similar to the cysts described in the first case. On histopatho­logical examination the cyst proved to be a cysticer­cosis cellulosae. The wound healed without any com­plication and there was no recurrence.

 Discussion



It is evident from the literature that in India commonest mode of presentation of ocular cysticercosis is sub-conjunctival involve­ment and the incidence is greater than in western countries.

The interesting features in both the cases were that cysts were seen in children. Nine out of ten cases have been reported under fifteen years of age [12] . Both were non-pork con­sumers. The most baffling feature being that in both cases two cysts were joined to each other through a common isthumus.

 Summary



Two cases of twin cysticercosis cellulosae cyst in conjunctival tissues of non-pork con­suming children under ten years of age, have been presented. Removal of cyst resulted in complete recovery without recurrence.

References

1Bakrishnan E. 1961, Brit. J. Ophihal. 45, 150.
2 Dyal Y. Sood, N.N. Goswamy V, and Agra S.K. 1970, Orient. Arch. Ophthal. 8. 212.
3Desai H.C., Shrama S.K. and Chandak G.K. 1972, Orient. Arch Ophthal. 10, 38.
4Eliot R.H. and Ingram A.C. 1911, Ind. Medical Gaz. 43, 215.
5Gupta A.N. and Mathur S.N. 1967, Orient. Arch. Ophthal. 5, 515.
6Malik S.R.K., Gupta A.K. and Chaudhari S.K. 1968, Amer. J. Ophthal. 66, 1168.
7Mehra K.S., Nema H.V., Nagarajachar J., Rajyashree K. and Rahi A.H. 1968, Acta Ophthal. 46, 980.
8Patoria N.K. and Junnarkar R.V. 1967, Report of a Case J. A. 11 Ind. Ophthal. Soc. 14, 227.
9Rao A.U.N., Satyandra C.M. and Sood N.N. 1967, Orient. Arch. Ophthal. 5, 249.
10Premprakash Dyal Y. and Sood N.N. 1972, Orient. Arch. Ophthal. 10, 202.
11 Ready M.V. and Satyandra O.M. 1967 Amer. J. Ophthal. 57, 664.
12Sen D.K. Mathur R.M. and Thomas A.A. 1969, Brit. J. Ophthal. 51, 630.
13Sen D. 1968, Orient. Arch. Ophthal. 6, 181.
14Sood N.N., Shukla K.N., Lamba P. and Madhravan M. 1970, Orient. Arch. Ophthal. 8, 29.