|Year : 1967 | Volume
| Issue : 1 | Page : 35-37
Hydatid cyst of the orbit
IS Roy, A Banerjee, PK Guha, AB Choudhury
Institute of Ophthalmology, Calcutta; School of Tropical Medicine, Calcutta, India
|Date of Web Publication||18-Jan-2008|
I S Roy
Institute of Ophthalmology, Calcutta; School of Tropical Medicine, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Roy I S, Banerjee A, Guha P K, Choudhury A B. Hydatid cyst of the orbit. Indian J Ophthalmol 1967;15:35-7
Compared with the other parts of the body ocular involvement of Hydatid cyst is rare. Orbital involvement is of Hydatid disease constitute only 0.7% to 1%, of the published cases. Since 1952 only five cases of orbital Hydatid cysts have been reported in the literature. Rapaport et al published one case from Argentine in 1957; Mazhar reported two cases of hydatid cyst of orbit from Aden in 1954; Tonjum reported one case from Sweden in 1963. As far as our knowledge goes Huilgol reported the first case of Hydatid cyst of orbit from Mysore in 1963. This case of ours is the first one from this part of the country.
It occurs commonly in countries where sheep and cattle raising is an industry and where exists a close association between sheep, the optimum intermediate host and man, and dog the optimum definitive host. That is the reason why it is so uncommon in a tropical country like India.
Dog is the optimum definitive host. The larval stage is passed in sheep, cattle, pig or man which represent the intermediate host of the parasite. The eggs swallowed by man, due to intimate handling of the infected dogs, reach the stomach where their cell walls are digested and active hexacanth embroys hatch out and bore their way through the walls of the gut and enter the portal circulation to reach the liver, the first filter. Due to the large size embroys they are mostly caught here producing here the highest incidence of hydatid cyst. If they escape this filter they are caught in the pulmonary bed, the second filter. If however they escape both these filters they may settle in one or other peripheral parts. This is the reason why orbital involvement is so extremely low.
The pericyst of the Hydatid cyst is essentially the product of the tissue reaction on the part of the host. Of the two proper cyst walls of the embryo the endocyst gives rise to scolices and brood capsule under suitable conditions. The rate of growth of `H' cyst is usually slow. There is not much predilection for sex or the site of the orbit; however, it is more commonly seen in the younger age group. The cyst may occur in any part of the orbit but more commonly in the upper quadrant.
Not having any clinical characteristics, diagnosis is extremely difficult and surgical exploration of the orbit has proved to be the most reliable method of diagnosis. Presence of the characteristic 3 paired hooklets under microscope from the scrapings of the lining of the cyst wall is confirmatory. Some clue may however be obtained from eosinophilia of blood and if the Casonis test if positive. The best form of treatment is extirpation of the cyst without puncture. Handousa and Tonjum opine that some portion of the fibrous pericyst be left during operation to prevent post-operative Enophthalmos.
| Case Report|| |
Shankari Bala Dasi, Hindu female child aced 7 was admitted in the Eve Infirmary, Medical College Hospital on 12-1 1-65 for the treatment of her left proptosis of 18 months duration. There was slight pain for the last 2 months.
There was definite history of intimacy with dogs.
On examination, a huge irreducible eccentric proptosis down and in on the left side was present. Extraocular movements were practically nil. Vision was reduced to finger counting from 1 metre.
Nothing abnormal was detected in the other systems, laboratory findings and X-Ray of the orbital foramina.
A Kronline type of lateral orbitotomy was performed and the large cystic mass deep in the orbit was isolated.
The cyst puncture revealed clear yellowish fluid with expulsion of sagograin like bodies and scraping from the cyst wall revealed scolices with typical 3 paired hooklets.
A week after the operation Casoni's test was performed and surprisingly it was found to be negative. Post operative recovery was uneventful, except for a lateral rectus palsy and some enophthalmos.
| Comments|| |
Deep seated position of the cyst in the orbit eluded its true nature till the surgical exploration was performed and the subsequent microscopy done.
That, Casonis test is not always reliable is proved by its negative result in this histologically confirmed case.
| References|| |
Chatter ice. K. D. Parasitology. 5 th
Duke Elder, S: Text Book of Ophthalmology, Vol. 4-1952 p. 5473-76.
Handousa Bey A: (1951). J. Opthalmology 35: 606-613.
Huilgol. A. V. (1963). J. All India Ophth. Soc. 11: 79-81.
Mazhar, M. (1954). Brit. J. Ophth. 38: 753.
Rapaport. M. et al: (1957). Rev. As Med. Argent. 71: 189-191.
Tonjum. A. M. (1963), Acta Ophth. 41: 445-448: 1963.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]