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| BRIEF REPORT |
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| Year : 2000 | Volume
: 48
| Issue : 1 | Page : 53-4 |
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Ascaris lumbricoides in the lacrimal passage
M Balasubramaniam, P Sudhakar, M Subhashini, S Srinivasan, M Padma, V Chopra
Department of Ophthalmology, Government Stanley Medical College & Hospital, Chennai-600 001, Tamil Nadu, India
Correspondence Address:
M Balasubramaniam
Department of Ophthalmology, Government Stanley Medical College & Hospital, Chennai-600 001, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 11271938 
Keywords: Animals, Ascariasis, diagnosis, parasitology, surgery, Ascaris lumbricoides, isolation & purification, Child, Diagnosis, Differential, Eye Infections, Parasitic, diagnosis, par
How to cite this article:
Balasubramaniam M, Sudhakar P, Subhashini M, Srinivasan S, Padma M, Chopra V. Ascaris lumbricoides in the lacrimal passage. Indian J Ophthalmol 2000;48:53 |
Ascaris lumbruicoides is the largest human nematode and affects approximately one quarter of the world's population. There have been several reports of ocular ascariasis. However, microscopical confirmation was not obtained in many of these cases and Toxocara could not be ruled out.[1] Kaplan et al first described an authentic case of an intact young adult Ascaris extracted from the nasolacrimal duct of an 18-month-old African girl from Durban, South Africa.[2] A similar case was reported by Roche, who found an Ascaris worm in the nasolacrimal duct.[3]
| Case Report | |  |
A 10-year-old boy presented to our outpatient department with irritation in the right eye of 3 days duration. On examination, a small white thread-like material was observed in the upper punctum. On closer examination, it appeared to be a small nematode showing some movements in the lacrimal passage. Under topical anesthesia, the worm was pulled out with forceps (Figure). It was found to be a white live roundworm 5cm long and 1.5 mm thick. The worm was identified by the Parasitology Department of the Chennai Veterinary College and was confirmed to be a live female immature Ascaris lumbricoides (Figure, inset).
The visual acuity was normal in both eyes. There was no allergic manifestation either in the conjunctiva or in general. Slitlamp examination of the eye was normal. The right nasolacrimal duct was free. Stool examination for ova and cyst for Ascaris was negative. Total and differential count showed no eosinophilia. The patient did not return for follow-up evaluation.
| Discussion | | |
Ascaris lumbricoides is the largest intestinal nematode parasitising man. Man is the only definitive host of Ascaris lumbricoides. This parasite is unique in that it passes its entire life cycle in one host. Continuance of the species is ensured by transference from one host to another. The female is capable of laying both fertilized and unfertilized eggs. The mature female worm has an enormous egglaying capacity, liberating about 200,000 eggs daily.
The various stages of the worm's life cycle include: (1) eggs in faeces, (2) development in soil, (3) infection by ingestion and liberation of larva, (4) migration - small intestine - portal circulation - liver - right heart - pulmonary circulation - lung alveoli, (5) re-entry into the stomach and the small intestine from the lung alveoli, and (6) sexual maturity and egg liberation. During migration, the Ascaris worm may accidentally enter the respiratory passage, lumen of the appendix, biliary passage and liver.
The eggs of Ascaris behave like an inert material. The larva produces an irritant fluid due to the presence of Ascarase, resulting in allergic manifestation. The body fluid of Ascaris lumbricoides, when absorbed, is toxic and may damage the tissues. The worm is known to cause subconjunctival mass, granulomatous iridocyclitis, choroiditis (macular or paramacular), recurrent vitreous haemorrhage, periphelebitis, papilloedema, chronic dacryocystitis and invasion into the subretinal space.[1]
Ascaris larvae do not normally develop in the eye, as shown by animal experiments with intraocular injection of Ascaris ova. In this boy, the possible way the worm could have reached the eye is, as described above during stage five, by the larvae crawling up the bronchi, trachea and the nasopharynx, and getting regurgitated into the nasolacrimal duct and then migrating out into the conjunctival sac through the lacrimal punctum. Our case is similar to the two cases described in the literature. [2,3]
Management of ascariasis includes treatment with either mebendazole (100 mg twice a day for 3 days) or pyrantel pamoate (11mg/kg/in single dose). For ectopic infections without systemic involvement, as in our case, surgical removal is the only therapy recommended in the literature.
| References | | |
| 1. | Kean BH, Sun T, Elsworth RM, Gansthomiasis. In Kean BH, Sun T, Elsworth RM (editors). Colour Atlas and Text Book of Ophthalmic Parasitology. New York, USA; Igaku-Shion;1991. p 108-11.  |
| 2. | Kaplan CS, Feedman L, Elsdon-Dew R. A worm in the eye: A familiar parasite in an unusual situation. S Afr Med J 1956;30:791-92. |
| 3. | Roche PJL. Ascaris in the lacrimal duct. Trans R Soc Trop Med Hyg 1971;65:540. |
[Figure - 1]
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