Live intraocular worm causing multifocal choroiditis Dr Mamta Agarwal Dr J Biswas

At presentation 43 yr / F 43 yr / F OD - C/O pain, redness & floaters x 1 week OD - C/O pain, redness & floaters x 1 week H/O decreased vision in right eye x 2 weeks H/O decreased vision in right eye x 2 weeks Diagnosis - ? Retinal exudates with macular odema Diagnosis - ? Retinal exudates with macular odema

Clinical findings BCVA OD – 6/12 OS – 6/6 BCVA OD – 6/12 OS – 6/6 SLE SLE OD – Circumcorneal congestion OD – Circumcorneal congestion Aqueous cells & flare 2+ Aqueous cells & flare 2+ A live, active vigorously moving thread A live, active vigorously moving thread like worm in the anterior chamber like worm in the anterior chamber OS - Normal OS - Normal

Slit lamp photo OD

Video

Treatment Surgical removal of the worm from the anterior chamber under local anesthesia Surgical removal of the worm from the anterior chamber under local anesthesia Microscope examination Microscope examination Dirofilaria tenuis ( 27 mm x 0.5 mm ) Dirofilaria tenuis ( 27 mm x 0.5 mm )

Fundus Multifocal choroiditis with RPE & chorioretinal with RPE & chorioretinal scars in the periphery. OD

Investigations Normal Normal Total & differential leucocyte count Total & differential leucocyte count Peripheral blood smear Peripheral blood smear Urine & stool test Urine & stool test

Treatment Diethyl carbamazine citrate (6mg/kg/day) given in two divided doses for 3 weeks. Diethyl carbamazine citrate (6mg/kg/day) given in two divided doses for 3 weeks.

Follow up After 1 month After 1 month BCVA OD – 6/6 BCVA OD – 6/6 Fundus Fundus OD - Healed choroiditis OD - Healed choroiditis OS - Normal OS - Normal

Fundus OD

Conclusion Live intraocular worm may present as acute iridocyclitis with multifocal choroiditis without any systemic complaints. Live intraocular worm may present as acute iridocyclitis with multifocal choroiditis without any systemic complaints. Surgical removal of the worm and antibiotic therapy results in resolution of choroiditis & improvement in visual acuity. Surgical removal of the worm and antibiotic therapy results in resolution of choroiditis & improvement in visual acuity.