|Year : 1983 | Volume
| Issue : 1 | Page : 23-25
Hydatid cyst of orbit
PA Lamba1, PC Bhatia1, Manju Jain1, Usha Baweja2
1 Guru Nanak Eye Centre, Maulana Azad Medical College New Delhi, India
2 Department of Microbiology, Maulana Azad Medical College New Delhi, India
P A Lamba
Professor Dept. of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education & Research, Pondicherry-605 006
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lamba P A, Bhatia P C, Jain M, Baweja U. Hydatid cyst of orbit. Indian J Ophthalmol 1983;31:23-5
Hydatid disease of orbit is more frequently seen as orbital cyst while cysticercus cellulosae shows more frequent ocular involvement. Intraocular hydatid cyst has been reported in a solitary case by Arora and Dhanda. Whereas the infection is acquired in childhood the cysts tend to grow in size over a period of years and the disease is not usually diagnosed before adult life.
From India, about 15 cases of Hydatid cyst of orbit have been reported so far. Sevel reviewed 11 cases of such orbital cyst occurring in South Africa. The present case is being reported with introduction of counter immunoelectrophoresis (CIEP) as a diagnostic test and an excellent post-operative recovery of vision following the removal of the cyst.
| Case report|| |
A young man presented with gradual protrusion and progressive diminution of vision of the right eye for 3 months. There was no history of trauma or passing worms in the stool.
Examination of the right eye revealed a proptosis of 7 mms and the globe was displaced laterally and downwards [Figure - 1]. There was a mechanical restriction of all the ocular movements specially in abduction and elevation. The optic disc showed papilloedema with gross engorgment of the retinal blood vessels. Visual acuity was finger counting at one foot with accurate projection of light.
A globular smooth surfaced, non tender mass was felt in the upper medial quadrant of the orbit. The swelling was non pulsatile and non reducible. Posterior limit of the mass could not be reached.
During the stay of the patient in the hospital a bluish discolouration with associated pain presented sub-conjunctively near the insertion of medial rectus. A tentative diagnosis of haemangiomatous growth or an orbital cyst (parasitic) was made. There was no hepatomegaly.
Investigations :-There was no eosinophilia and the stool failed to demonstrate the presence of ova or cyst. Casoni s test was positive. Counter immuno-electrophoresis test showed a clear precipitation line indicating the test to be positive [Figure - 2]. Radiological examination of orbit and optic foremen were normal.
Anterior orbitotomy was performed transconjunctivally through upper nasal quadrant and a bluish cystic swelling was visualised [Figure - 3] The cyst was seen to have split the medial rectus muscle and superficial muscle fibres gave a bluish tinge to the shining white cyst wall [Figure - 3]. The cyst could be removed in toto. During post operative period, the patient was kept on systemic and local steroid therapy. The eye ball receded the oedema of' the disc disappeared and unaided visual acuity regained was 6/9.
| Discussion|| |
The hydatid disease is regionally orientated and is common in countries where sheepraising constitutes an important industry and consequently where dog and men come into very close contact. The human infection usually occurs due to eating unboiled raw vegetables which are contaminated by the excreta of dogs containing ova of echinococcus.
The most common site for the development of hydatid cyst is the liver and lungs which act as two natural filters during the process of migration of the larvae from the gut. This also explains the infrequent involvement of the ocular and brain tissue in this disease.
Hydatid cysts in rare sites pose a diagnostic problem. Available diagnostic methods include Casoni's test which is positive in 75% cases. The recognition of a specific immune response in the intermediate host is a sensitive and accurate diagnostic precedure in hydatid disease. Casoni's intradermal test shows an immediate hypersensitivity reaction with high sensitivity but its low specificity has made the interpretation of results rather difficult. The recently developed counter immunoelectrophoresis test which produces counter migration of through a gel of antigens, immunoglobulins and forms a line of precipitation which is considered to be of greater accuracy but only positive results are considered helpful. This test has been adapted to diagnose hydatid disease with high sensitivity and specificity. The microscopic diagnosis rests upon finding of scolices of hooklets from cystic fluid or a characteristic laminated structure (ectocyst) like the coats of an onion. Once the diagnosis of hydatid cyst is made, operation becomes mandatory, in order to avoid the complications like anaphylaxis, infection of the cyst and pressure symptoms. The excellent recovery of visual acuity in the present case is believed to be due to the release of the pressure over the optic nerve.
The authors feel that formalin should never be injected into the cyst since it rapidly diffuses into the orbital tissue with disasterous blinding results. Sevel advocated lateral orbital approach (modified Burki's procedure) over transcutaneous technique of removal of hydatid cyst of orbit. Use of systemic steroids post- operatively is recommended.
| Summary|| |
A case of orbital hydatid cyst, atypically situated splitting the medial rectus, diagnosed by positive Casoni and counter immuno-electrophoresis test is reported. The value of CIEP test as a diagnostic aid in hydatid cysts has bene introduced.
| References|| |
Nath, K, Gopi, R. and Gopalakrishnan, 1977, Ind. J. Ophthalmol. 25 : 24.
Arora, M.M. and Dhanda R.P., 1964, Brit. J. Ophthalmol. 48 : 507.
Sevel, D.. 1977, Surv. of Ophthalmol, 22 : 101.
Raims, A.J. H. and Ritchie, M.D., 1977, Practice of Surgery. Baily & Love, Londcn H.K. Lewis & Co., p. 859.
Kagan, 1.G., 1968, Bulletin, WHO 39; 25.
[Figure - 1], [Figure - 2], [Figure - 3]