Indian Journal of Ophthalmology

CASE REPORT
Year
: 1980  |  Volume : 28  |  Issue : 4  |  Page : 219--220

Case of cysticercosis presenting with persistant 'diplopia' and spontaneous extrusion


G Baskararajan, A Srinivasan, P Sivaramasubramanian, S Thiyagarajan 
 Department of Ophthalmology, Government Rajaji Hospital, Madurai, India

Correspondence Address:
G Baskararajan
Department of Ophthalmology, Government Rajaji Hospital, Madurai
India




How to cite this article:
Baskararajan G, Srinivasan A, Sivaramasubramanian P, Thiyagarajan S. Case of cysticercosis presenting with persistant 'diplopia' and spontaneous extrusion.Indian J Ophthalmol 1980;28:219-220


How to cite this URL:
Baskararajan G, Srinivasan A, Sivaramasubramanian P, Thiyagarajan S. Case of cysticercosis presenting with persistant 'diplopia' and spontaneous extrusion. Indian J Ophthalmol [serial online] 1980 [cited 2020 Apr 2 ];28:219-220
Available from: http://www.ijo.in/text.asp?1980/28/4/219/28261


Full Text

A peep into the ophthalmic literature reveals that ocular cysticercosis is not an uncommon one. But the various unusual presentations of the cyst, like its site, laterality, relation to the structures of eye have made it a curiosity. Intra-ocular bilateral presentation[1], cysticercosis in anterior chamber[2], sponta­neous extrusion of cysticercus from sub-con­junctival space[3], fundus photography of the movements of cysticercus in vitreous cavity[4], cysticercus in lid[5] and cyst causing sub-conjunc­tival abscess[6] have all been recorded. Following is the report of an unusual case of cysti­cercus with diplopia as the presenting com­plaint and spontaneous extrusion of the cyst subsequently.

 CASE REPORT



A 14 year old male patient "S" reported with the complaints of diplopia and pain in the left eye of one week duration. Previously seen 1 year back for diplopia of 1 year dura­tion wheel was treated with anti tuberculous. drugs. Examination revealed minimal eccen­tric proptosis of the left eye. Diplopia chart interpreted a restriction of abduction on the left side. Routine investigations such as haematological picture, Mantoux, ESR and X-ray orbit were not contributory except for the eosinophilia. On the third day, the patient came with severe pain and redness. There was seen a localised swelling deep to the lateral canthus of the left eye. The next day, cystic swelling with milk-spot became obvious and clinically cysticercus cyst was confirmed. Excision of cyst was planned, but two hours prior to the surgery, the patient came with a translucent globular cyst protrud­ing from the swelling [Figure 1]. Within a few minutes the Cyst came out spontaneously with undulating movements. Histological study confirmed the diagnosis. The cavity where the cyst was lodged was explored and the granula­tion tissue from the site curetted. The patient had good recovery and diplopia disappeared after three weeks.

 DISCUSSION



Cysticercus cellulose is the resting stage of Taenia solium larva in the intermediate host. A study of distribution in the body by Malik et a1[7]. has brought to light that the ocular cysticercosis accounts for 12.8% in a study of 110 cases. A study of the distribu­tion in various structures of the eye shows that the order of priority is sub-conjuctival, intra-vitreal, sub-retinal, anterior chamber, orbit and lids. In western reports, sub con­junctival deposition is less common. The left eye is more commonly affected than the right, the reason being the origin of the left carotid artery directly from the arch of aorta.

In this case the affected eye was the left one in conformity with the available reports. The presentation of the cyst in orbit with recurrent diplopia as the presenting symptom has not so far been reported. The cause of diplopia may be attributed to the inflammatory reaction shared by lateral rectus muscle[6]

Since there was no clinical evidence of the presence of the cyst in this case when the patient reported first with diplopia, it can be assumed that the cyst was deposited in the posterior orbit. Subsequently it should have migrated forwards and got extruded spontaneously.

 SUMMARY



An unusual case of cysticercus cyst in orbit causing recurrent diplopia and later extruding spontaneously is reported.

 ACKNOWLEDGEMENT



The authors wish to thank the Dean, Government Rajaji Hopital, Madurai for permitting to publish this material.

References

1Balakrishnan, S. 1961, Brit. J. Ophthalmol. 45 150.
2Mathur and Abraham, 1964, Arch. of Ophthalmol.,67:562.
3Reddy, P.S. Satyendran and Sivaramakrishnan,1970, Acta Ophthalmologica, 48;312
4Meyersons and Pienaar 1961, Brit. J. Ophthalmol. 45;148.
5Jampol, L.M., 1972, Arch. Ophthalmol.89:319.
6Thomas, S.D.K., 1969, Amer. J. Ophthalmol,68:714.
7Malik, S.R.K., Gupta A.K. and Chowdhurys 1966, Amer. J. Ophthalmol. 57:665.