Indian Journal of Ophthalmology

CASE REPORT
Year
: 1996  |  Volume : 44  |  Issue : 4  |  Page : 229--231

Orbital myocysticercosis presenting as subconjunctival abscess


AK Grover, Pankaj Puri 
 Department of Ophthalmology, Sir Ganga Ram Hospital, New Delhi, India

Correspondence Address:
A K Grover
Department of Ophthalmology, Sir Ganga Ram Hospital, New Delhi
India




How to cite this article:
Grover A K, Puri P. Orbital myocysticercosis presenting as subconjunctival abscess.Indian J Ophthalmol 1996;44:229-231


How to cite this URL:
Grover A K, Puri P. Orbital myocysticercosis presenting as subconjunctival abscess. Indian J Ophthalmol [serial online] 1996 [cited 2020 Jan 27 ];44:229-231
Available from: http://www.ijo.in/text.asp?1996/44/4/229/24566


Full Text

Cysticercus cellulose, the larval stage of taneia solium is usually found in pig. Man gets infested by ingestion of eggs form contaminated soil or food. The commonest pattern of systemic involvement is neurocysticercosis. Ocular adenexal infestation is unusual. Orbital cysticercosis is reported to be commoner in this part of the world. The presentations in these cases are varied, the common ones being proptosis and sub-conjunctival cyst.[1],[2] Unusual presentations of cysticercosis can be highly misleading and may lead to a wrong diagnosis.

This communication reports an unusual case of orbital myocysticercosis which presented as a case of subconjunctival abcess. To our knowledge this has not been reported earlier.

 CASE REPORT



A 42 year old male presented to us with the complaints of swelling, discomfort and acute pain in the right eye for a period of 15 days. There was no history of trauma or any surgical intervention. The patient was a pork eater.

Examination revealed a large subconjunctival swelling on temporal aspect [Figure:1]. The conjunctiva over the swelling was grossly congested and showed a whitish discoloration suggestive of an abcess. There was marked mucopurulent discharge. A provisional diagnosis of subconjunctival abcess was made.

The patient was started on local and systemic antibiotics. Blood profile was unremarkable except for a neutrophilic leucocytosis (78%). the orbital ultrasonography revealed an enlargement of the lateral rectus muscle with a well defined cystic lesion with an eccentric hyperechoic area suggestive of a scolex [Figure:2]. Axial computerized tomographic scan revealed a nonenhancing soft tissue lesion closely abutting the lateral wall of the globe along the lateral wall of the orbit [Figure:3]a,[Figure:3]b. The lateral rectus muscle was not separately defined. Coronal scans showed a low attenuating centre surrounded by a thick enhancing peripheral rim inseparable from the lateral rectus muscle suggesting orbital myocysticercosis in the extraconal space [Figure:3]c,[Figure:3]d.

At surgery a large amount of pus was drained out. A cyst with a well defined scolex extruded out spontaneously thereafter [Figure:4]. Histopathology confirmed the diagnosis of myocysticercosis. No organisms were isolated from pus.

 DISCUSSION



Orbital myocysticercosis is a relatively rare condition. The presentation of orbital myocysticercosis as an abcess has not been reported earlier. The aetiology of pus in this case is not clear.The pus could have been due to bacterial super infection and the failure to isolate the organism may be due to prior institution of antibiotic therapy. However it is difficult to explain how bacterial infection occurred in the absence of an external wound. The other explanation for a sterile abcess caused by inflammation induced by leakage from the cyst.

The unusual presentation of cysticercosis such as this in the orbit presents a diagnostic dilemma. A high index of suspicion in countries as ours where the condition is relatively more common is necessary to diagnose these cases. Imaging techniques provide the diagnosis. Serology (ELISA test) for cysticercosis has not prove helpful in our experience, which has been corroborated by others in the country.

References

1Malik S.R.K, Gupta A.K., Choudhary S. Ocular cysticercosis: Am of Ophthalmol.66:1168-71, 1968.
2Agrawal PK, Kumar H, Agarwal M, Nasum J. Orbital cysticercosis - A clinicopathologic profile. In: Pasricha JK, ed. Indian Ophthalmology Today - 1994: Proceedings of the 52nd Annual conference of the All India Ophthalmological Society, Calcutta, 1992. New Delhi, 1994, pp 388.