Case Report: Molecular Detection and Characterization of Trypanosoma cruzi in Ocular Tissue from Donors with Chagas Disease.

Corneal transplantation is the most frequent transplant worldwide. Tissue characteristics allow storage and transport, even between continents, increasing its accessibility around the world. Donor infection with Trypanosoma cruzi is not defined as a corneal discarding factor, although the transplant is not recommended preventively, as in any infectious diseases. Herein, by means of polymerase chain reaction (PCR) strategies, we analyzed parasite presence in ocular tissue from 10 deceased donors with Chagas diseases. Among them, positive findings were obtained in corneas, scleras, and eye muscle samples of three, two, and one donor, respectively. Moreover, among the six T. cruzi defined populations, TcV and TcVI parasites were found in some samples based on group-specific amplification strategies. Our findings point out the actual possibility of T. cruzi transmission due to corneal transplantation and makes donor's serological status knowledge mandatory regardless of graft provenance. Failing that, we suggest a posttransplant follow-up of recipients from seropositive donors.

Three unusual cases of parasites in eye.

A 17-year-old male patient presented with cellulitis and mass in the eye noticed approximately 3 months back. The mass was about 1 cm in size and situated at the limbus. All preoperative routine investigations were normal. Surgical exploration revealed a sub-conjunctival cystic mass near the lateral rectus muscle about 1 cm in diameter; the mass was excised. Gross pathological examination revealed a thin-walled cystic mass. There was a hard nodule in the center. Microscopy revealed a wall of cysticercosis. Scolex was also seen. Surrounding tissue revealed sparse acute and chronic inflammatory cells. The case was confirmed by CDC, Atlanta, and was also included in their departmental presentation as an interesting case. A 60-year-old lady presented with complaints of itching over the forehead and right eye for 5 days. She was prescribed steroid eyedrops and antihistaminics. The itching aggravated with eyedrops along with watering and foreign body sensation. On revisit, the ophthalmologist noticed a worm in the right upper subconjunctival space. The worm was carefully removed in toto and sent to the laboratory for identification. The worm was thin, cylindrical, 8-10 cm long and white in color. After microscopic and gross examination of the worm, it was identified as Dirofilaria spp. CDC (Atlanta) confirmed the diagnosis of Dirofilaria. The patient was treated with antihistaminics and was relieved of symptoms without recurrence. A 45-year-old male patient had a painless mass in the eye for the last 3 months. He had no systemic illness. He gave a history of swimming pool use during that time. The mass was excised and submitted for histopathology. Numerous globular cysts representing thick-walled sporangia containing numerous spores diagnostic of Rhinosporidiosis were seen.

Orbital cysticercosis.

A young male patient presented to our ocular emergency department with chief complaints of progressive pain, redness, diplopia and a right-sided face turn. Ocular examination revealed severely restricted extraocular movements along with retinal folds in the left eye. Initial orbital ultrasound and CT findings were equivocal; however, serology favoured an infective cause. Considering the endemicity of the disease and equivocal investigation findings, a diagnosis of orbital cysticercosis with an atypical presentation was made. The patient was managed medically with a combination of oral albendazole and steroids over a period of 6 weeks to achieve optimal results.

Cysticercosis Masquerading as Lipo-Dermoid.

Cysticercosis is caused by the larval stage of Taenia solium (Pork tape worm). Humans are the definitive hosts where the life cycle is completed and pig is the intermediate host. Incidence in India varies from 2-38% based on the consumption of pork, general hygiene and socio-economic status of the population. The parasite on reaching the small intestine encysts itself in various tissues. Most commonly Brain, Eyes, subcutaneous tissue. Intravitreal cyst is the commonest intra ocular presentation. Death of the parasite and release of the contents of the cyst causes an intense inflammatory reaction that can be devastating. We report the condition in a nine-year-old boy who presented with mild right upper lid swelling wherein cysticercus cellulosae cyst was found within the mass of the right lateral rectus muscle. It becomes important to report this case because of the unusual site of the cyst which masqueraded as a lipo-dermoid.

Dacryoadenitis and extraocular muscle inflammation associated with contact lens-related Acanthamoeba keratitis: A case report and review of the literature.

The present report discusses a new case of dacryoadenitis with extraocular muscle inflammation associated with Acanthamoeba keratitis (AK) in a contact lens wearer. A 41-year-old male, who has worn silicone hydrogel contact lenses on an extended basis for about 10 years, attended with the complaints of vision disturbance, hyperemia, and pain in his right eye. His history revealed that 1.5 month ago, he had been diagnosed with allergic conjunctivitis and had used steroid eye drops. Biomicroscopic examination revealed eyelid edema, chemosis, and ring infiltration, radial keratoneuritis and an epithelial defect in the cornea. Magnetic resonance imaging demonstrated enlarged lacrimal gland with edematous changes consistent with inflammation due to dacryoadenitis. There were also thickening and edema of the right superior oblique and lateral rectus muscle. The treatment protocol for AK was applied with no specific treatment for dacryoadenitis. After 4 months of the treatment, dacryoadenitis and keratitis regressed. Dacryoadenitis and extraocular muscle inflammation may accompany AK more frequently than expected and previously known. The evaluation of the lacrimal gland and extraocular muscles in presence of AK might be beneficial for understanding better the exact clinical picture and course of the keratitis.

An orbital hydatid cyst involving inferior rectus muscle: A case report.

The orbital hydatid cyst is a rare entity and although most of them are located in superolateral and superomedial angles of orbits, involvement of inferior sites is uncommon. We report a 12-year-old case of primary hydatid cyst situated in inferior rectus muscle which was undergone surgical removal. Magnetic resonance imaging (MRI) was used for differential diagnosis of hydatid cyst. Moreover, histological analysis was performed, after the cyst removal, to confirm the diagnosis. Early clinical and radiological evaluations and subsequent surgical excision is the mainstay of treatment and should be performed to prevent severe complications caused by the advanced and ruptured cysts.

A rare case of isolated cysticercus involvement of inferior rectus muscle presenting with upward gaze restriction.

Cysticercosis is a parasitic infection caused by larvae known as cysticercus cellulosae. Orbital cysticercosis is usually a part of generalised systemic infestation. Isolated infection of the extra-occular muscle is an extremely rare entity. Involvement of orbital adnexas are rare even if associated with brain infection. Here, we report a case of an 18-year-old boy who presented with eccentric proptosis and restriction in upward gaze and was diagnosed with cysticercosis of inferior rectus.

A new surgical "noose" technique for excision of pediatric ocular adnexal and anterior orbital cysts.

We describe a "noose technique" that facilitates complete surgical excision of all forms of pediatric adnexal and anterior orbital extraocular cysts, including conjunctival retention cysts, parasitic cysts involving the conjunctiva, Tenon's capsule, or rectus muscle, superficial cysts, and deep dermoid cysts. The technique provides good exposure and facilitates handling of tissues, maintains surgical planes, minimizes bleeding, decreases injury to collateral tissues, reduces surgical time, allows for utilization of less skilled assistants, and ensures complete excision in most cases. The noose technique is a versatile procedure that can be applied to extraocular cysts of any location or size both in children and adults. We demonstrate the technique in 3 different pediatric extraocular cysts.

Surgical Excision of Orbital Cysticercosis Lodged in Superior Oblique Muscle: Clinical Case Report.

Ocular cysticercosis refers to parasitic infections in humans. Most cases were treated by medicine. The case we reviewed was rarely reported with successful surgical intervention treatment.This case report describes a patient with cysticercosis existing in superior oblique tendon. The main symptom of the patient was recurring history of painless orbital swelling and double vision in upgaze. Ocular motility examination revealed a restriction of the right eye in levoelevation. A contrast-enhanced computed tomographic scan of the orbit revealed the presence of a well-defined hypodense cystic lesion within the right superior oblique muscle.The patient was diagnosed with orbital space-occupying mass with acquired Brown syndrome. Surgical exploration of the superior oblique muscle was performed, and the cyst was removed from the eye and confirmed by histopathological examination. After surgery, an ocular motility examination revealed orthotropia in the primary position and downgaze, with mild restriction in levoelevation.Surgical removal could substitute for medical therapy when the cysticercosis is lodged in the superior oblique muscle, although, prior to surgery, important factors, such as patient requirements, surgical skills of the surgeon, and cyst placement, should be considered.

Ocular myocysticercosis: an unusual case of ptosis.

BACKGROUND: Cysticercosis is common in endemic countries like India. It can have various clinical manifestations depending on the tissue involved. It refers to a parasitic infestation by Cysticercus cellulosae, the larval form of the pork tapeworm or Taenia solium. OBJECTIVE: To report an unusual case of ocular cysticercosis involving the levator palpebrae superioris and superior rectus muscle of the right eye. CASE DESCRIPTION: A young, male adult was diagnosed by Magnetic Resonance Imaging (MRI) scan of the skull and orbit to have right-sided ocular cysticercosis. The patient was treated with oral prednisolone and albendazole, to which he showed a significant improvement. CONCLUSION: Ocular myocysticercosis can be diagnosed by MRI and be treated medically with steroid and albendazole.

Ptosis: a rare presentation of ocular cysticercosis.

BACKGROUND: Cysticercosis is a common parasitic infection involving multiple systems and caused by Cysticercus cellulosae, the larval form of the cestode, Taenia solium. The humans become infected by ingesting its eggs from contaminated food. Here, we present a case of ocular cysticercosis which presented with mild pain, ptosis, inflammation of upper eyelid and slightly restricted ocular motility. CASE: A twelve-year-old girl presented with mild pain, unilateral ptosis and inflammation of the right upper eyelid for seven months. There was no history of diurnal variation and trauma. There was neither protrusion of the eyeball nor any mass was palpable in periorbital area. Visual acuity in both the eyes was normal. Periocular and ocular examination revealed a slightly restricted ocular motility in the right upward gaze and a reduced vertical fissure height a with good levator palpebrae function. The Bell's phenomenon was good. The magnetic resonance imaging of the orbit showed an intra-conal retro-orbital mass involving the superior rectus muscle of the right eye suggestive of ocular cysticercosis. The orbital sonogram revealed a cystic lesion in the superior rectus muscle with an echogenic intramural nodule. The enzyme-linked immunosorbent assay for serum antibodies against the cysticercus was positive. The ptosis improved with a therapeutic trial of albendazole and oral steroids for 6 weeks. CONCLUSION: Extra-ocular cysticercosis can be treated with oral steroid and albendazole.

Multiple brain parenchymal neurocysticercosis with extraocular muscle cysticercosis affecting levator palpebral superioris and superior rectus complex: an unusual association.

An 8-year-old girl presented to the neurology department with a complaint of insidious onset of left-sided ptosis and restricted elevation of the left eye. A CT scan orbit and brain revealed a ring-enhancing lesion in the levator palpebral superioris (LPS) and superior rectus (SR) muscle complex of the left eye and left parietal and right temporal region. She was started on steroid, followed by albendazole with improvement. The LPS/SR complex is the least common site of involvement among extraocular muscles in ocular cysticercosis. Specially, with brain neurocysticercosis (NCC), it is extremely rare. We report an unusual association of multiple brain NCC with ocular cysticercosis involving LPS and SR muscle.

Ocular myocysticercosis: favorable outcomes with early diagnosis and appropriate therapy.

BACKGROUND: Ocular myocysticercosis is rare and a high index of suspicion is required for its diagnosis. OBJECTIVE: To describe clinical characteristics and treatment outcome of ocular myocysticercosis. CASES: We describe a series of three patients who had different clinical presentations of ocular myocysticerocosis namely diplopia, restricted ocular motility and sub-conjunctival cyst. The treatment with oral albendazole and prednisolone was effective in all three cases. CONCLUSION: Favorable outcomes can be achieved with a high index of suspicion, early diagnosis and treatment with oral albendazole and prednisolone in patients with ocular myocysticercosis.

Proptosis of eyeball in children with medial rectus cysticercosis: report of 2 cases.

PURPOSE: To report 2 children with medial rectus cysticercosis presenting as proptosis of eyeball. METHODS: Case report. RESULTS: In orbital cysticercosis, extraocular muscle cysticercosis is the most common type. Two children, a 12-year-old girl and an 8 year-old boy, presented with proptosis and pain in the left eye. Both were diagnosed with medial rectus cysticercosis based on computed tomographic scan and serologic report and treated with oral albendazole and prednisolone without any residual ocular motility restriction. CONCLUSIONS: We report 2 cases of medial rectus muscle enlargement caused by cysticercosis; describe its clinical importance, diagnosis, and treatment; and present a review of the literature.

Extraocular muscle cysticercosis: clinical features and management outcome.

BACKGROUND: Extraocular muscle cysticercosis is rare and can be classified based on the stage of evolution as viable, degenerating, and inactive. A tailored approach to therapy using a combination of albendazole and steroids has been proposed. In this study, we have evaluated the clinical features and response of "viable" extraocular muscle cysticercosis to a tailored therapy with oral albendazole and steroids. METHODS: A retrospective review of 32 patients with viable extraocular muscle cysticercosis was performed over a 3-year period. Ultrasound examination was performed at 3 weeks and 6 weeks for resolution of the cyst and clinical signs following treatment with oral albendazole and prednisolone. The clinical presentation, ocular alignment, motility restriction, and ultrasound examination details were recorded on serial visits. RESULTS: The mean age was 19.5 years. The most common presenting signs included limitation of ocular motility in 75%, conjunctival mass in 37.5%, diplopia in 28.1%, and proptosis in 28.1% of the patients, respectively. Ocular alignment evaluation revealed esotropia in 3.1%, exotropia in 12.5%, and hypertropia in 6.25%. Restriction of abduction and abduction in elevation was present in two patients each. The average time for complete resolution was 65.9 days. All the patients had resolution, except four, who had residual motility limitation but were asymptomatic. CONCLUSIONS: Combination therapy with oral albendazole and steroids is effective in the management of viable extraocular muscle cysticercosis. However, residual motility restriction may persist despite treatment.