Cutaneous myiasis of the eyelid masquerading as periorbital cellulitis

A 49 year old man was referred to the internal medicine service at St Joseph's Hospital in Hamilton, Ontario, Canada. The patient had a six day history of pain and redness of his right lower eyelid, which started following a puncture wound sustained while welding. His only recent travel was a hunting trip to Northern Ontario. There was right eye periorbital redness and swelling, and there was a small fluctuant lesion on the lower eyelid. On close examination of the lesion, movement beneath the skin was observed. At this time the diagnosis of cutaneous myiasis was considered. The lesion was occluded with antibiotic ointment to encourage the parasite to emerge; within 30 minutes the larva was extracted with forceps. It was identified as an early instar larva of the genus Cuterebra, a North American botfly. The patient received antibiotics for secondary bacterial infection, and made a complete and uneventful recovery.

Figure 1 Recently extracted parasite (foreground) and host (background).