|Year : 1976 | Volume
| Issue : 1 | Page : 34-36
Enterobius vermicularis in the human conjunctival sac
LP Dutta, SN Kalita
Assam Medical College, Dibrugarh, India
L P Dutta
Assam Medical College, Dibrugarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dutta L P, Kalita S N. Enterobius vermicularis in the human conjunctival sac. Indian J Ophthalmol 1976;24:34-6
A very peculiar case of Enterobius vermicularis so far not found in literature has been reported.
| Case Report|| |
A young lady in her early teens was confronted with a very embarrassing situation. One night at bed time she felt smartness in her left eye. Soon after that, she could feel something crawling out of the eye towards the cheek. She caught hold of the object with fingers and saw that it was a tiny white living creature. She kept quiet. The same thing repeated every night at bed time for the next two days. On the 4th night, when one after another, three such worms came out from the same eye, she got alarmed and decided to confide her mother about the experience.
A girl aged 15,. the eldest child in a family of six of a school teacher, was referred by the local physician, with complaints of small white worms coming out from the left eye for the last 7 days. A sample of 4 such worms bottled in preservative were sent along with the patient. On examination there was slight whitish sero-purulent discharge from the left eye. Her vision was normal. She was admitted into the hospital.
She was co-operative and intelligent. On the first three days of her hospitalisation, every evening between 19 to 21 hours, worms were found to come out from the left eye. In those three days 8 such worms were collected. On fourth day the authors sat by her bedside to exclude possibility of willful external contamination by the patient herself. At 19.15 hours the patient stated that she was getting the familiar sensation which immediately preceded the expulsion of the worm. After 10 minutes of her warning a worm truly became visible in the lower lid. The worm was removed; this was followed by another in about 10 minutes appearing in the same spot.
Samples of the worms were sent to the Department of Microbiology of Gauhati Medical College, and the Department of Parasitology, Assam Veterinary College for opinion. Diagnosis from both the places came as gravid Enterobius Vermicularis [Figure - 1].
Investigations : Local examination under slit lamp did not reveal any abnormal tract or pockets in the conjunctival sac. Naso-lacrimal duct was patent. Examination of saline washing obtained from the lacrimal sac and the nasal sinuses for the worm or its ova was negative. Repeated examination of stools after purging, for presence of thread worm was negative. There was no eosinophilia in blood. Conjunctival swab culture showed growth of staphylococcus albus in the right eye, staph, albus and Friedlander pnezuztobacilus in the left eye.
The patient went on expelling worms, regularly for the first 12 days then irregularly for another 9 days of hospitalisation. The maximum number expelled in a single day was 4, and the total number of worms expelled were 42; all were identical.
Treatment : Treatment was empirical, and was started from the 7th day of admission. It consisted of washing the conjunctival sac and naso-lacrimal duct with normal saline and amithocane in succession, each without any fruitful result. Lastly a washing solution was made with an oral piperazine citrate preparation diluted in distilled water. The dilution which did not show any signs of irritation in the rabbit's eye was used. Results were very encouraging. Number of worms expelled dropped, and from the 5th day of this wash no worms were expelled.
She was discharged after observing for 10 more days. During the followup for 3 years there was no reaurrever.
| Discussion|| |
Enterobius vermicularis is a small-intestinal nematode. The gravid female migrates at night to the anus to deposit ova in the perianal skin. Reinfection by mouth takes place commonly by finger-contamination. From the ingested ovum a rhabditiform larva is hatched out in the intestine. The adults live in cecum. The oesophagial bulb in the adults and in addition the unique shape of the ova in case of the gravid females are diagnostic. Man is the only known host of this parasite, and it does not need a second host or a vector. It is relatively harmless; anal pruritus in children is the common complaint it produces.
An unusual lesion produced by this intestinal parasite, that has been recorded on rare occasion, is salpingitis. This occurs due to re-entry of the female worms after laying eggs in the perianal skin, through vagina to reach the tubes. In the text book of Manson's Tropical disease, one can read that-"occasionally Enterobius vermicularis may be found in the female genital organs, rarely in the ear and nose". In the present case the worms were found to come out through the eye. Investigations failed to locate the source. Nose and nasal sinuses possibly were not the source. In that case, some of the worms would have migrated through the nose as well. The source remains obscure. We venture to suggest that, infection took place with a big inoculum, in the fingernail from a crushed gravid female, which was deposited in the conjunctival sac. A diverticula in the lacrimal sac or the lacrimal gland was the site of development of the larva, where they grew into adult males and females. Under natural biological instinct, the gravid females started to migrate to the neighbouring mucocutaneous area to lay eggs.
| Summary|| |
A case, which appears to be the first of its kind in the medical literature, of Enterobius vermicularis infestation of the human conjunctiva) sac is reported. The possibility of mode of infection is hinted upon.
| References|| |
Manson-Bahr, P.H., 1950, Mansons' Tropical Diseases,
Cassell and Company Ltd. p., 988.
Wu, D.Y., 1935, Trans. Trop. Med., 1, 605.
[Figure - 1]