Year : 1990 | Volume
: 38 | Issue : 4 | Page : 178--179
Nematode in the retina
CBM Ophthalmic Institute, Little Flower Hospital, Angamally-683 572, India
T P Ittyerah
CBM Ophthalmic Institute, Little Flower Hospital, Angamally-683 572
An unidentified nematode in the retina of an otherwise healthy young lady causing inflammation and exudation is reported. The worm was destroyed by Xenon photocoagulation, There was complete recovery and remarkable improvement in visual acuity.
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Ittyerah T P. Nematode in the retina.Indian J Ophthalmol 1990;38:178-179
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Ittyerah T P. Nematode in the retina. Indian J Ophthalmol [serial online] 1990 [cited 2024 Mar 4 ];38:178-179
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Parasitic invasion of the eye is not a very rare occurance in India. There are several reports of different types of nematode affecting the eye. ,, There are interesting references of unidentified nematodes affecting the retina and leading to loss of vision. Gass and Braustein  described this condition in detail and named it as diffuse unilateral subacute neuroretinitis syndrome. The present case report deals with the observation of an unidentified nematode in the retina and it's manage�ment.
A 22 years old Christian lady attended the out patient department for defective vision in her left eye of one week duration. There was no other complaint and she was not suffering from any other disease to her knowledge. Examination revealed a well built lady without any apparent disease. Her visual acuity in the affected eye was 6/18 and the fellow eye 6/6. There was macular oedema and serous detachment oft e macula.
She was treated as a case of central serous retinopathy (CSR) with Ibuprofen and Vitamin C for one week. Since there was no relief she was examined in the retinal clinic in detail, the vision had gone down to counting fingers close to face. The fundus showed oedema of the retina with small multiple haemorrhages all over and a scat�tered distribution of brown pigments on the retina in certain areas. The most fascinating findings in the retina was a very rapidly moving nematode in the retina with serous detachmnt of the retina around it. [Figure 1] She was admitted and investigated in detail. The general examination by Physician, Gynaecologist and Der�matologist did not reveal any abnormality. Haematologi�cal examination also was within normal limits. Eosonophilis were only 4 in the differential count and night blood was negative for microfilaria done consecu�tively for 3 days.
The worm when it had moved away from the macula was photocoagulated using a Xenon Log 2 Photocoagulator. It was difficult to shoot at the worm because of the rapid movements and the moment the light was focussed on it, it changed the position. When one shot was given at its head end its body it became chalky white and straightened. [Figure 2]
Supportive treatment was given with steroids and the patient completely recovered from the inflammation and vision improved to 6/18. The worm gradually disin�tegrated and we could not find any trace of the worm when she was reviewed after a month.
Clinical presentation as serous d etachment of macula is interesting. CSR being uncommon is womem, serous detachment of macula occuring in a lady should make one think of other possibilities.
The early detection of the worm and its desctruction by photocoagulation has prevented severe complications and complete loss of vision. Attempt to remove the worm surgically should be avoided because it may cause considerable damage to the retina. Always one may not be able to locate it and remove it since it is very much mobile. The best treatment available is photocoagula�tion. This can be done with least harm when the worm moves away from the macula. The worm being not pigmented more power was required to destroy it. The only disadvantage is that the toxins liberated from the dead worm may harm the retina and produce severe retinal inflamation. In this case perhaps heat coagulation of the protein in the worm might have rendered the toxins less irritant to the retina. The inflamation of retina could be controlled with anti-inflamatory agents.
|Donald M.Gass and Rober Braustein, Archives of Ophthalmology, 101. p. 1689,1983.
|Thomas A., Molly M.O. and Ittyerah T.P... ACTA, 6th Afro Asian Congress of Ophthalmology, Madras, 1976..
|Thomas, A, Ittyerah T.P., Menon S. and Abraham J.C., Eastern Archieves of Ophthalmology. 2, p. 295. 1974.