|Year : 1978 | Volume
| Issue : 2 | Page : 42-45
C Syamala Baskaran1, R Musalappa Reddy2, M Venkatamuni1, M Venkateswarlu2
1 Department of Pathology, S.V. Medical College, Tirupati, India
2 Department of Ophthalmology, S.V. Medical College, Tirupati, India
C Syamala Baskaran
Department of Pathology, S.V. Medical College, Tirupati
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baskaran C S, Reddy R M, Venkatamuni M, Venkateswarlu M. Ocular cysticercosis. Indian J Ophthalmol 1978;26:42-5
Cysticercosis in man is an infestation with larval stage of T. solium. The adult worm is a parasite of man, but unlike T. saginata, the larval stage, although usually occurs in the pig, can also develop in man. This may be due to autoinfection either by faeco-oral route or by reverse periostalis the mature proglottides from small intestines are carried to the stomach or is acquired by ingestion of raw or undercooked meat containing cysticercosis. In the stomach, the oncosphere penetrate the wall of the stomach and gets through the blood stream to various organs where, they encyst and form cysticerci. The cysts in man lodge frequently in muscles, central nervous system and in the eye ,,,. Involvement of the latter two sites are the serious consequences of human cysticercosis.
In the eye cysticerci may be situated intraocularly or extraocularly. Within the eye, cysticerci occur in vitreous body ; and sub retinal,, but some may be found in the anterior chamber and sub conjunctiva. The most damaging location is intravitreous and sub retinal location which leads to blindness in 3 to 5 years unless the parasite is removed.
| Material and Methods|| |
During a period of 5 years we have seen 11 cases of ocular cysticercosis. The findings are summarised in [Table - 1].
| Results|| |
In all the cases there was no clinical or radiological evidence of cysticerci either in the skull or subcutaneous tissue except in case No. 8. In 3 cases (case No. 7, 8 and 9) active rhythmic movements of the scolex could be demonstrated. Often the position of scolex appeared as a white spot [Figure - 1] Blood eosinophilia was present in 5 out of 6 examined. Only one case showed ova of Teneia in motion out of 6 cases examined. In 2 cases (9 and 10) repeated examination after administering mild laxative did not reveal ova.
| Gross Findings|| |
The cysts were either globular or elongated and oval. They varied from cm to a maximum of 3 cms, long. Except in case No. 10, the rest of the cases showed transparent thin walled cyst with a white area of 2 mm diameter [Figure - 2]. When freshly removed and kept in normal saline the scolex showed active movements well seen with a hand lens. In case No. 10 the cyst was just behind the lens and was surrounded by thick fibrous bands. The Vitreous showed pale, yellow bodies and the retina was. drawn towards the cyst by adhesions. In case No. 9, the cyst was located medial to the macula sub retinally and the retina was detached. The vitreous showed fine yellow bodies.
| Histopathology|| |
In all the cases except in case No, 9, the structure of cysticerci was demonstrated [Figure - 3]. The membrane that forms the wall of the cyst consist of an outer row of cilia set on a basal amorphous layer. In 7 cases the cysts the cellular reaction in surrounding area mild with few eosinophils and lymphocytes. The intravitreous cyst (case No. 9) showed degeneration of the cyst wall with florid inflammatory response consisting of eosinophils, polymorphs with granulomatous reaction, and giant cell formation. It has been clearly shown by Mac Arthur and Shouramma and Reddy that the tissue reaction is less or minimal, when the cyst is alive than when it is dead, and it is it due to gradual absorption of the dead parasite results in violent tissue reaction. Further, clusters of foamy macrophages were seen in vitreous and uveal tract. The retina showed vacuolar degenerative changes in nuclear zone in cases No. 9 and 10 with detachment from pigmented area.
| Comment|| |
Out of 6 cases examined for ova of Tenia in the motion, only one gave positive result. The absence of tape worm in the intestine can be explained by the fact that Indians of low socioeconomic status defaecates in the open and the same area is used by them to play and hence faeco-oral root of infection is possible akin to autoinfection. Hence adult worm may not be present in the intestine. This could also explain the absence of ova in the motion of many cases. Eating uncooked pork in India is rather rare.
Therefore most probably the infection by cysticercosis may be by faeco oral route.
It has been noted by Reddy and Satyendran that ocular cysticercosis were seen more often in children. Out of 10 cases reported by them 9 occurred below 15 years. In our series, 6 out of 11 cases were children below 15 years. However no age is exempt as could be seen. from our studies.
In this series, the location of the cysts were mostly in subconjunctival region. Only in 3, the cysts were either located in anterior chamber, vitreous or in sub retina. Malik et al reported 10 subconjunctival cysticercosis out of 12 cases reported. Similar findings were reported by Sen and Thomas. However Leigner Terrase reviewed 35 cases from literature and reported 16 in subretinal region; intravitreous 10, subconjunctival 7 and anterior chamber sclera-1.
There was no difference in the incidence of cysts on the right or left side. It has been pointed out by Malik et al that the left eye is more commonly involved. This feature has been explained by them that the left Internal carotid artery directly originate from the aorta and the blood flow is in direct line with it and hence larvae more often enters left carotid than the right. However we could not substantiate their findings.
In 3 cases of intra ocular cysticercosis, in two, the lesions were severe with loss of vision. In a single case of anterior chamber cysticercosis the patient died due to intracranial cysticercosis. If cysts are located either subconjunctivally or extraocularly, the lesions are not severe and loss of vision was not present in our cases. Hence, it is important to diagnose intraocular cysticercosis early before much damage is done and early removal of the cyst is recommended by pars plana approach using a cryoprobe as described by Shea et al and Hutton et al before devastating lesions like retinal detachment inflammation of the uvea can occur.
| Summary|| |
Eleven cases of ocular cysticercosis are described. It has been shown that cysts can be seen in any part of the eye but most often they are seen in sub conjunctival area. If it is situated in the intraocular tissue, it will cause visual disturbances, with loss of eye sight. Hence it is essential to diagnose intraocular cysticercosis early and necessary treatment be given before any severe damage results.
| References|| |
Bhaskaran, C.S. 1973, Ind. J. Med. Sci. 27,
Dixon, H B.F. and Hergreaves, W. H. 1944, Quart. J. Med. 13,
Hutton, L. H. Vaiser, A and Snyder, W. B. S., 1976, Am. J. Ophthalmo!, 8,
Leigner-Terrase 1940, cited by Duke-Elder. Text Book of Ophthalmology, Lond. Kimptom. 3438.
Lench (Jr) 1949, Am. J. Ophthalmol, 32,
Malik. S.R.K. Gupta A.K. and Chudhry, S. 1968. Am. J. Ophthalmol., 66,
Mac Arthur, W.P. 1934 Trans. Roy. Soc. Trop. Med. & Hyg., 27,
Menon, T.B. & Valiath, G.D. 1940, Roy. Soc. Trop. Med. & Hyg., 33,
Reddy, P.S. & Reddy, D.B. 1957. Current Med. Pract., 1,
Reddy, P.S. & Satyendran, O.M. 1964. Am. J. Ophthalmol., 57,
Sen, D.K. & Thomas, A. 1968, Arch. Ophthalmol., 80,
Shea, M. Maberley, A.L. Walters, J. Freeman, R.S. & Fallis, A.M. 1973. Trans. Am. Acad. Ophthalmol., 77, 778.
Shouramma, A & Reddy D.B. 1963, Ind. J. Path. & Bact., 6, 142.
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1]