Abstract
A 22 years old male presented to us with a history of lid swelling and chemosis of conjunctiva since 2 days. The patient had a history of convulsions 4 days back and 2 months back. The patient had undergone a CT scan which showed granulomas in temporal and parietal lobes. The patient was started on Anti tuberculosis treatment by the Physician. The Patient underwent USG B scan which revealed cysticercosis cyst in the anterior orbit inferiorly .The patient was treated with albendazole and wysolone for a month. The patient was reviewed after 1 month .The lesion resolved with the treatment both clinically and on USG.
Keywords: Cysticercosis, Orbit, USG B scan
Introduction
Cysticercosis is the infestation by Cysticercus cellulosae, the larval form of the pork tapeworm, Taenia solium. It is contracted by (a) ingestion of the infective cysticerci in under cooked pork; (b) Ingestion of eggs of T. solium in contaminated water, food or vegetables; and (c) Regurgitation of eggs from the small intestine.1,2
The sites for predilection for the development of cysticerci are the central nervous system, subcutaneous tissue, skeletal muscle, heart muscle and the eye.2
Ocular cysticercosis is common in the Indian subcontinent.4
We report a case of anterior orbital cysticercosis in a person hailing from Mumbai.
Case report
A 22 year old male, non-vegetarian, presented to us with a history of swelling and redness of the left eye since 1 day. Patient had a history of convulsions 2 months back and took treatment for the same from the physician. EEG was done which showed neuronal hyperexcitability. Patient had a history of convulsions 4 days back and was admitted for the same and investigated. EEG was done 4 days back which showed neuronal hyperexcitability at subcortical level.
CT scan was done 4 days back and showed granulomas in the right temporal and parietal lobes & possibility of cysticercosis and tuberculomas to be considered.
He was started on Tab. Eptoin and Anti tuberculosis treatment.
O/E UCVA in RE 6/6 and LE 6/9
The anterior segment examination in the LE revealed lid swelling and chemosis of conjunctiva. Rest of the examination was normal.
The patient was advised B scan which revealed left sided cystic mass lesion 9 × 7 mm in the inferior quadrant of the orbit with a scolex within it due to the cysticercosis (Fig 1). The patient was treated with Tab albendazole (400 mg) for 1 month. Tab Eptoin (100 mg) 1-0-2 and Tab Wysolone (20 mg) 1-1-1 as advised by neurophysician was continued.
Figure 1.
Orbit showing cystic mass lesion with scolex within it.
The patient was reviewed after a month. The UCVA was 6/6 in RE and 6/9 in LE.
The anterior segment and posterior segment was normal in both eyes. The lid oedema and chemosis had resolved in the LE.
The B scan was repeated which showed a Left sided small cystic lesion in the orbital cavity anteriorly due to an old cysticercosis lesion. As compared to the previous USG there was significant reduction in the size of the lesion.
Discussion
Ocular dissemination of cysticercus cellulosae is well known. Sommering3 first reported a case of ocular cysticercosis in 1980. In the eye, the most common site for cysticerus cellulosae is vitreous and sub retinal spaces5, followed by orbit and adnexal tissues. The extra ocular muscle is the commonest type of orbital and adnexal cysticercosis.3,6–8 Lodgement of the cysts in the sub conjunctival space is another common site, followed by the eyelid, optic nerve retro-orbital space and lacrimal gland.6,7
The clinical manifestation of the orbital or adnexal cysticercosis is entirely different and depends on the location, size, relation to the adjacent structures and the stage of evolution of the cyst.
Diagnosis of cysticercosis is based mainly on orbital imaging because of its specific appearance.8 Tissue diagnosis is not essential for initiating treatment. Medical therapy is the recommended treatment for the extraocular muscle form and retro-orbital cysticercosis. Surgical removal is advocated for the sub conjunctival and eyelid cysticercosis. Because of the limited number of cases or optic nerve and lacrimal gland cysticercosis, their treatment is controversial.7,8
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