|Year : 1967 | Volume
| Issue : 3 | Page : 120-122
Hydatid cyst of the orbit
IS Jain, Ved Rangbulla
Department of Ophthalmology, Institute of Post Graduate Medical Education and Research, Chandigarh, India
|Date of Web Publication||21-Jan-2008|
I S Jain
Department of Ophthalmology, Institute of Post Graduate Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain I S, Rangbulla V. Hydatid cyst of the orbit. Indian J Ophthalmol 1967;15:120-2
Hydatid disease of the orbit is of comparatively rare occurrence. The incidence of the orbital hydatid is about 1 % of all the published cases. (Duke Elder 1953).
Since hydatid disease is rather common in the Punjab, the following case report is of interest as parasitic cyst can be a cause of unilateral proptosis in children where hydatid disease is endemic. It is perhaps the 3rd report from this part of the country. (Previous cases are by Ramalingam 1962; Huilgol 1963).
| Report of the Case|| |
A female patient aged 10 years from Digshai, Distt. Simla, came to the eye department for the first time on 28-7-1965 with the complaint of protrusion of the left eyeball since one month.
About 1½ months ago she started feeling pain in the upper left half of the face more in the evenings.
About 1 month ago the eye ball started protruding gradually. Redness in the outer part of the bulbar conjunctiva appeared along with the protrusion. There was no history of fever, trauma, or any bleeding disorder. The patient did not complain of any pain in the bones or abdomen. [Figure - 1]
| Local Examination|| |
Palpebral fissure on the left side was widened. The patient could not close the eye completely. Fullness above the upper lid on the outer side was present. The bulbar conjunctiva was congested on the outer side [Figure - 1]. Cornea, iris, Pupil and lens were normal. Fundi were normal, ocular movements were restricted in all directions. Some movement was present in the inner lower direction. No pulsation or bruit was present. The right eye was norma1.
Visual acuity of the right eye was 6/9 and of the left 6/60.
General examination revealed slight temp. (99°F), the liver was just palpable on deep inspiration but the spleen was not palpable. Lymph nodes were not enlarged.
| Investigations|| |
Examination of the blood and urine showed nothing abnormal. X-Ray examination of the chest abdomen and of the optic feramina were non-contributory.
| Treatment and Progress|| |
Patient was initially put on antibiotic systemically and locally. On the third day she developed 102°F fever with congestion of throat, which subsided within three days with increased close of crystalline penicillin.
Conjunctivitis appeared in the left eye which was cured within 3 to 4 days with the usual local treatment.
Proptosis gradually decreased during her stay in the Hospital in about 25 days time but there was hardly any improvement in the vision. On retraction of the upper eyelid a cystic swelling in the outer and upper part was felt when the patient looked down and in. The conjunctiva over it was congested but there was no tenderness. All the borders could not be defined. On 24th August, aspiration was tried but no fluid could be drawn out. On making a small incision thin dirty yellowish pus came out. On widening the incision with an artery forceps, a whitish semitransparent cyst [Figure - 2] about the size of a human lens suddenly got ejected intact. [Figure - 2]
Staph. albus could be cultured from the pus. The cyst on histopathological examination proved to be a hydatid cyst. [Figure - 3],[Figure - 4]
Cesoni's test (done after the report) was positive.
On subsequent interrogation, history of keeping a dog in the house for the last two months was available.
After operation [Figure - 6] there was marked improvement in the movement, almost normal in the lower and inward directions. There was slight restriction of upwards movement but not much improvement in the movement outwards.
The left eye vision could now be improved to 6/ 12 and with -1.5 D sph. to 6/6-P.
| Comments|| |
Hydatid cysts tend to occur preferably in young people and more than half the cases are seen between the ages of 10 and 30 years. There is however no difference between both the sexes and the orbits are equally liable to be affected. The clinical course is insidious and the full picture develops in a few months. When fully developed, the classical diagnostic triad of proptosis, tumor and pain occurs. The proptosis is irreducible with no special characteritics. A sudden exacerbation of pain, increase in proptosis and local inflammatory reaction in the eye is an important diagnostic clue to hydatid cyst as an etiological agent. The present case report is of great interest to the paedeatricians and ophthalmologists as it presented a classical clinical course.
| Summary|| |
A girl aged 10 years had developed proptosis, a cystic swelling in the upper and outer part of the left orbit and pain in the left half of the face. On making an incision in the conjunctiva over the swelling, a translucent cyst of the size of a human lens got ejected. Hydatid nature of the cyst was established on histopathological examination. Staph. albus could be cultivated from the dirty-yellowish purulent contents. Cesoni's test was positive.
| Acknowledgements|| |
We are indebted to Professor B. K. Aiket and Dr. B. N. Dutta, Department of Pathology, Post Graduate Institute, Chandigarh for examining the specimen and providing the microphotographs.
| References|| |
Duke Eider: Text Book of Ophthalmology. Vol. V. P. 5473. Henry Kimpton (London) 1952.
Huilgol. A. V.: (1963) J. All-India Ophthalmological Society, 11, 79.
Ramalingam T. T.: Ocular Localisation in Tropical Parasitological disease. See (1962) Abstract of 19th International Congress of Ophthalmology, P. 6.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]