1. External ophthalmomyiasis manifesting with kerato-uveitis Published in International Ophthalmology
Sonia Attia, MD
Sana Khochtali, MD
Nesrine Abroug, MD
Moncef Khairallah, MD
Department of ophthalmology
Fattouma Bourguiba University Hospital
Faculty of Medicine,University of Monastir
Monastir, Tunisia

2. Ocular History A 77 year-old healthy man, living in a rural region
Painful red, foreign body sensation and photophobia of the right eye of 4-days duration

3. First Presentation Visual acuity OD counting fingers, OS 20/63
Congested conjunctiva
diffuse corneal edema associated with subepithelial numerous linear opacities
2+ aqueous flare and 1+ cells
granulomatous corneal precipitates

4. First Presentation Intraocular pressure was normal bilaterally
Bilateral nuclear sclerotic cataract
Fundus examination was unremarkable in both eyes

5. Initial diagnosis and treatment
A diagnosis of presumed herpetic keratouveitis was made
The patient was treated with a combination of topical ganciclovir 5 times/ day and topical dexamethasone 6 times/day .

6. Follow-up One day later
Slit lamp examination  an approximately 1-mm-long, translucent, light-sensitive, rapidly moving maggot on the conjunctiva, under the upper lid, and on the corneal surface

7. External Ophthalmomyiasis manifesting with Keratouveitis
Final Diagnosis
larvae of Oestrus ovis
External Ophthalmomyiasis manifesting with Keratouveitis

8. Outcome
Following removal of the maggot and instillation of tobramycin, the symptoms completely resolved within 2 days

9. Conclusion
External ophthalmomyiais usually manifests with ocular surface involvement
This diagnosis as an uncommon condition must be considered in the differential diagnosis of keratouveitis especially in rural areas