A Man With Unilateral Ocular Pain and Blindness

Abstract

A 25-year-old black man with unknown medical history presented at our ophthalmologic mobile outpatient clinic (District of Sankuru, East Kasai Province, Democratic Republic of Congo) with blindness and pain in his left eye. The examination showed a shrunken, nonfunctional left eye ( phthisis bulbi), nonreactive to light, which, by slit lamp exam, revealed a large, blackish, crescent-shaped, worm-like foreign body wedged into the angle of the anterior chamber (Figure 1). Much to our surprise, the foreign body began a peristaltic motion upon physical stimulation of the eye. The patient was otherwise in good health and free of general symptoms. Physical findings were unremarkable; thus, no further diagnostic tests were performed. The parasite was removed under local anesthesia, still alive and crawling (Figure 2). It was sent to the Hungarian Natural History Museum, Budapest, for further identification. The patient often consumed poorly cooked snakes. Despite the surgical procedure, the patient permanently lost vision in the left eye. What is your diagnosis?

Ocular Pentastomiasis in the Democratic Republic of the Congo

“…In 13 patients with intraocular infection (including the current cases) signs and symptoms were the following: decreased vision (12/13 patients, 92%), eye pain in 8/13 (62%), conjunctival injection in 5/13 (39%), and photophobia, excessive lacrimation in 1/13 (7.7%) [10], [14]–[18], [23], [24], [25], [26]. In cases of posterior chamber localization, retinal detachment occurred in 3/4 cases (75%).…”

“…The parasite was motile and was removed under local anesthesia. This case was previously reported as a photo quiz [10]. Subsequently, the extracted nymph was morphologically and molecularly examined (unpublished data).…”

“…Anterior chamber localization caused iritis/uveitis in 5/9 patients (56%) with or without elevated intraocular pressure and goniosynechiae. Iridodonesis was present in 3/9 (33%), dislocated lens in 2/9 patients (22%) [10], [14]–[18], [24], [26]. Intraocular parasites caused permanent visual damage in 9/13 (69%) and total loss of vision in 4/13 cases (31%).…”

“…Identification was based on morphology of the nymphs in 10/13 and on PCR in 3/13 patients. The parasites were removed successfully in 10/13 of the cases [10], [14]–[18], [23], [24], [25], [26]. Surgical intervention could improve vision in two patients only (Table 2.…”

Co-infections in Visceral Pentastomiasis, Democratic Republic of the Congo

“…Adult Armillifer pentastomids inhabit the respiratory tract of large snakes (final hosts), where they sexually reproduce, resulting in shedding of infective ova into the environment by snake feces or respiratory secretions ( 5 , 6 ). In natural intermediate hosts (rodents and small monkeys), and accidentally humans, larvae hatch in the gastrointestinal tract after ingestion of pentastomid eggs, leading to dissemination and, eventually, to encapsulation of the vermiform larvae in internal organs (most often abdominal or peritoneal organs [visceral pentastomiasis ( 1 )]) or in the eye (ocular pentastomiasis ( 7 , 8 )]). Visceral pentastomiasis is often asymptomatic and an incidental finding during surgery or autopsy, and pentastomid larvae occasionally might be seen on radiologic films ( 1 ).…”