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| ARTICLES |
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| Year : 1977 | Volume
: 25
| Issue : 1 | Page : 24-27 |
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Orbital cysticercosis
K Nath, R Gogi, Gopal Krishna
A.M.U. Institute of Ophthalmology, Aligarh, India
Correspondence Address:
K Nath
A. M. U. Institute of Ophthalmology, Aligarh, (U.P.)
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 612587 
How to cite this article:
Nath K, Gogi R, Krishna G. Orbital cysticercosis. Indian J Ophthalmol 1977;25:24-7 |
One of the most important parasites which frequently causes blindness in human is the larvel form of Taenia solium or pork tapeworm called cysticercus cellulosae. Ocular cysticercus is a rare disease and is known since the times of Hippocrates, Aristophanes and Aristotile. [12]
Cysticercus cellulosae is bladder worm stage of Taenia solium. It is characterized by scolex with its stickers and crown hooks. Human infection may occur on taking raw infected pork containing visible cysticercus cellulosae-`Meashy-pork', food or water contaminated with faecal matter containing ova or an autoinfection. [34] The ovum reaches the stomach, develops into an embryo which make its way into circulation and lodges in various organs of the body.
Since the first case report by Sommering [32] , a number of reports have been published. [10],[11],[12],[18],[31],[37],[38],[39] From India cysticercus infection in the eye has been reported by various workers. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[36],[40]. The subretinal space seems to be favourite site for this parasite followed by sub conjuctival tissues [Table - 1]. Orbit is a rare site for cysticercus cellulosae. There are 24 such cases on records [Table - 1], and we document another such case in a Hindu vegetarian female.
| Case Report | |  |
A Hindu 14 year old vegetarian Jain female patient resident of Agra, reported to eye out patient department of A. M. U. Institute of Ophthalmology, Aligarh with the complaint of ptosis left upper lid for 18 months. Twenty days later she developed pain in the orbit and eye started buidging forward gradually and attained this protrusion. There was no history of diplopid. On examination of left eye, the visual acuity was 6/6. The proptosis was forwards (6mm), downwards (8 mm), and outwards (2 mm), The intraorbital pressure was raised. On digital palpation it was not tender and no palpable mass was found. The amount of ptosis was 5 mm in forward gaze. The action of levator was weak. Ocular movements were restricted on direct elevation and dextruelevation, There was light congestion of fornices and the fundus showed blurred hyperaemic disc with tortuouous blood vessels as compared to right eye fundus The right eye was normal.
On the laboratory investigations the E.S.R, was raised to 56 mm, TLC was 7,2001cu mm with 16% eosinophils. Repeated microscopic examination of stools by direct and concentration methods did not reveral any evidence of parasitic infection. V.D.R.L., and Mauntox's tests were negative: Radiographic examination of the skull and orbit did not show anything positive.
Lateral cum anterior orbitotomy was done. Growth was palpated on medial side and under the roof of the orbit. While dissecting the fibrous covering of the growth suddenly cream colour pus came out of it, this was followed by extrusion of a cystic translucent mass. The cavity was scraped and filled with streptopencillin powder and wound was stitched in layers.
On gross examination, the cyst was oval and measured 1.0 X 0.5 cm, with translucent walls and a white opaque dot like area at one point which indicated the position of scolex [Figure - 1]. On histological examination the presence of body canal lined by epithelium confirmed the diagnosis [Figure - 2].
Hence on the basis of gross and microscopic examination, the diagnosis of cysticercus cellulose of the orbit was established.
| Comments | | |
In the present case clinically it was not possible to pinpoint the exact diagnosis. It was only at the time of operation when cysticercus infection was suspected and was confirmed later on by histopathological examnation. Presence of increased number of eosinophils in the blood could only indicate the diagnosis. In suspected cases complement fixation test can be of some value. [31] In 50% of cases Casoni test may be positive. [14]
Taenia solium is reported to be more common in younger age group. [10],[12],[15] Involvement of the left eye in the present case and as explained by other workers [13],[24] can have anatomical reasons for this predilection, as the left common carotid artery arises directly from the arch of aorta and disseminates the parasites more towards left eye. Inside the orbit, the orbital lesion was localized on the nasal side, which may be due to the course of ophthalmic artery which after giving off lacrimal branches runs along the medial side of the orbit and divides into its terminal branches. [13] Ptosis may be due to extension of the cyst in to the levator causing mechanical restriction of its action.
Cysticercus cellulosae is common in the pork eaters, whereas the present case belongs to rigid vegetarian Jain family. It is possible that patient might have had this infection following ingestion of infected food or water.
| Summary | | |
A case of orbital cysticercus in a Hindu Jain vegetarian female has been reported. It was present on medial side of the left orbit. Diagnosis was made only at the time of operation and was confirmed histopathologically.
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[Figure - 1], [Figure - 2]
[Table - 1]
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