|Year : 1976 | Volume
| Issue : 3 | Page : 22-24
Hydatid cyst of the orbit
KG Tehra, Mala Kamble, NK Patoria
Govt. Medical College, Nagpur, India
K G Tehra
Govt. Medical College, Nagpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tehra K G, Kamble M, Patoria N K. Hydatid cyst of the orbit. Indian J Ophthalmol 1976;24:22-4
Hydatid disease is caused by the larvae of Echinococcus granulosus, a small tape worm of dogs and wolves. It has got widespread distribution in the world, more common in temperate than in tropical countries. Sheep and cattle are the main intermediate hosts, human beings are also occasional sufferers. In this disease mostly the lungs, liver, or brain is affected. Hydatid cyst of the orbit is relatively rare. Orbital involvement is 1 % of total hydatid cyst disease, and 0.7% to 1 % of all orbital cases.
Very few cases of orbital hydatid cyst have been reported in India, in most of the cases there was involvement of upper and inner quadrant of right orbit, and they were of youngerage groups, between 10 to 30 years. Clinically the diagnosis of hydatid cyst of the orbit is difficult. The triad of symptoms described in hydatid cyst of the orbit are proptosis, tumour and pain. Positive Casoni's test and presence of eosinophilia are helpful in diagnosis. In many cases diagnosis is made on operation table after exploration for biopsy or aspiration of the fluid in suspected cases.
| Case Report|| |
A 40 years old Hindu male farmer from village Gumgaon, district Chindwada, was admitted in ophthalmic ward with the complaints of forward bulging of left eye since 12 months and gradual diminution of vision since six months. Patient was completely alright 12 months back when he noticed small swelling on the upper and inner side of left eye, which gradually increased to the present size. He also noticed gradual diminution of vision in the same eye since last 6 months, There was no history of any pain, or fever or of keeping pet dog at home. On examination there was pronounced proptosis of left eye, the eyebrow was elevated. there was marked fullness in the upper and inner quadrant of orbit, the eye ball was pushed forward, downward and laterally without any deviation in the long axis [Figure - 1] The palpebral aperture was wide and the medial canthus was displaced downward. There was ectropion of lower lid on medial side. He could close the eye with some difficulty. All the movements of the eye ball were restricted and were not pain full. The cornea was bright, pupil was semidilated and sluggish in reaction to direct light, Vision was reduced to finger counting one meter. Exophthalmometry reading was 35 mm. On palpation orbital resistance was increased, there was a swelling in the upper and inner quadrant of the orbit, firm and elastic in consistency with some tenderness. Orbital margins were normal. On slight manual elevation of the upper lid and voluntary closer of the eye produced further protrusion and luxation of the globe.
Fundus examination revealed 2 dioptre papilloedema with fullness and tortusity of the veins. Arteries were normal and there were no haemorrhages or exudates. The other eye was normal with 6/6 vision.
| Investigation|| |
Heamoglobin was 60 %. Total leucocytic count was 9000/ cu. mm. Differential leucocytic count showed polymorph 51 %, lymphocytes 34% and eosinophils 4%. ESR was 20 mm. at the end of 1st hr. by Wintrobe. VDRL test was negative. Urine examination for sugar and albumin was negative. Stool examination for ova and cyst was negative. Mantoux test was positive with 14 mm. reading. Casoni's test could not be done because of non availablity of hydatid fluid. X-ray skull showed slight enlargement of orbital cavity with no bony erosion. X-ray for optic foramin, paranasal sinuses, chest and abdomen for soft tissue were normal.
After investigations, thinking it to be some benign orbital tumour. patient was kept for excision biopsy. Exploration of the orbit was done by anterior approach in the upper and inner quadrant. After incising the orbital septum a bluish-white cyst was seen which could be separated easily on the anterior surface. Through the translucent wall of the cyst, circular yellowish white daughter cysts of different sizes could be seen. Anterior surface of the cyst measured about 4 cms. As it was difficult to excise it completely without rupture the cyst was aspirated with needle. About 20 ml of clear fluid came out with number of small yellowish white circular daughter cysts of different sizes. Simultaneusly the proptosis settled down with considerable laxity of the skin of upper lid. Before doing further dissection the puncture site of the wall was held with artery forceps. The cyst was attached to the bone on the upper and medial side of the muscle cone. Complete cyst wall was removed and sent for histopathological examination. The aspirated fluid was negative for any hooklets or scolices. The cyst wall showed typical characteristic laminated strucure.
There was no allergic reaction during postoperative period. There was considerable oedema of the lids on postoperative first few days.
| Discussion|| |
Hydatid cyst of the orbit is a rare cause of proptosis. It is seen in more than 50 % of cases at the younger age groups between 10-30 years. In most of the cases there was involvement of right orbit with location of the cyst in upper and inner quadrant of the orbit. The diagnosis is confirmed on aspiration or after exploration for biopsy. The presence of hooklets or scolices in aspirated fluid is pathognomic, but it may be sterile in many orbital cyst probably because of the pressure exerted. The cyst wall shows characteristic laminated structure under microscope. Papilloedema is seen in most of the cases due to pressure effect. In some cases vision may be affected early due to optic neuritis.
In this case there was involvement of the left orbit with location of the cyst in upper and inner quadrant, and the age of the patient was 40 years which is relatively on higher side. The proptosis was so much that on slight elevation of upper lid and voluntary closure of the lids produced luxation of the globe. Vision was reduced to one metre finger counting and there was no recovery in vision after the exision of the cyst. The papilloedema disappeared without any changes of optic atrophy.
| Summary|| |
A case of hydatid cyst of the left orbit is reported in a 40-year Hindu male.
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[Figure - 1], [Figure - 2], [Figure - 3]