|Year : 1979 | Volume
| Issue : 4 | Page : 226
Rare involvement of peri orbital tissue and eye in amoebiasis
Roopchand Mugarjee Lane, Calcutta-25
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Datta A. Rare involvement of peri orbital tissue and eye in amoebiasis. Indian J Ophthalmol 1979;27:226
Amoebiasis is a disease caused by infection of the tissues by the protozoon `Entamoeba histolytica'. The infection is usually in the wall of the large intestine but may extend from this region to any other tissue of the body. Amoebic infection of the orbit is extremely rare.
| Case Report|| |
P.B., a hindu young male aged about 30, attended my hospital clinic on 30.9.69, with the complaint of redness of his left eye for last 15 days. It was associated with intense headache and vomiting. There was no history of injury to the eye.
Right eye (RE) was found to be normal in all respects. In left eye (LE -there were signs of conjunctivitis and scleritis. Cornea was clear. A nodular swelling was found over sclera at about 1-0' clock position. The ocular movements were slightly restricted. Vision: 6/12, Fundus was normal except some pigmentation at macula.
A week later, the chemosis of conjunctiva was increased. The LE was found to be proptosed, which was axial in nature. There were signs of corneal involvement. Oozing of serosanguinous discharge started from left ear which was associated with deafness and vomiting. The scleral nodule was bigger in size. 6th nerve and 7th nerve palsy was noted on the left side. Proptosis increased day by day. A few days later, the 9th, 10th, 11th and 12th nerve palsy were noted. After about the 3rd week-the scleral nodule burst out and frank pus came out.
The vision of L.E. further deteriorated and was reduced to 6/24.
A few days later-there were 7th and 8th nerve palsy of right side. The vision of R.E. came down to 6/9.
The left eye continued to buldge out causing keratitis and legophthalmos.
All laboratory investigations were noncontributory. The x-ray of the orbit showed some enlargement. Pus from the orbit was sterile.
Systemic steroids and antibiotics were ueless.
Patient was lost to follow up for 2 years when he reported with loss of equilibrium and deafness. Left eye developed endophthalmitis as a complication of lagophthalmus.
Finding E. hystolitica cyst in the stool the patient was put on antiamoebic treatment. Within 7 days he responded dramatically. Most of the cranial nerve palsies showed recovery. Patient died of intercurrent infection on 7.1.72.
The intraocular architecture was disrupted due to chronic inflammation and fibrosis. The inflammatory cells were lymphoid in type admixed with a fair number of plasma cells. In some areas, vegetative phase of a protozoon was seen. These had amphophilic cytoplasm with irregular borders with projections. The nucleus was vesicular and a central keryosome was identifiable by Heidenhain hat matoxylin staining. These organisms showed positive periodic acid-schiff reaction. A clear space surrounded the crganisms which were interpreted as Entamoeba hystolytica.
N.B. Photographs, x-ray of orbits and microphotographs of slide were shown at the conference.
| Acknowledgement|| |
I am grateful to Surgeon Superintendent, Calcutta Medical Research Institute for allowing me to publish the article. Prof. N.K. Munshi, Head of the Department of Ophthalmology, Calcutta Medical Research Institute for guidance and summerisation. Brig. M. Roy for Histropathological study and Dr. Santanu Sen and Dr. G. Das, Eye Surgeons for helping me to prepare the article.