Bilateral Intra-Ocular Cysticerci

Abstract

CASES of intra-ocular Cysticercus usually affect only one eye, and bilateral cases such as that reported below are very rare.Case Report A man aged 55 years attended the hospital complaining of gradual loss of vision in both eyes for one year. He was not a vegetarian and was accustomed to eating pork.Examination.-The anterior segments of the eyes were normal. The visual acuity in the right eye was perception of light in all quadrants; in the left eye counting fingers I m.The right fundus showed extensive chorio-retinitis proliferans in the upper quadrants. A vitreous cyst occupied the lower temporal quadrant between 6 and 9 o'clock and covered the macular region. The shortest distance between the edge of the cyst and the optic disc was 5 disc diameters. It appeared to be bilobulate with a sharp luminous border, and a thin transparent wall. No movement of the cyst was detected though it was watched by many surgeons; a doubtful undulating movement of the portion of the wall nearest to the optic disc was occasionally noticed by the writer, but this was dismissed as being due to imagination.The left fundus also showed extensive chorio-retinitis proliferans around the optic disc, and a sub-retinal cyst occupied the area between 7 and 9 o'clock in the lower nasal quadrant. The shortest distance between the edge of the cyst and the optic disc was 6 disc diameters. The cyst was transparent with retinal vessels running over it and a clear luminous border. In the centre was a whitish circumscribed area, suggesting the scolex. No movement of the cyst was noticed, and perhaps none was possible because of its sub-retinal situation.There was no evidence of the presence of Cysticercus in any other part of the body. The motions were examined repeatedly but no tapeworm segment was detected.X-ray examination of the skull was normal. The liver and spleen were not enlarged. There were no subcutaneous nodules. The total white blood cell count was 8,000 per cmm. and the differential count showed 18 per cent. eosinophilia. Blood tests for venereal disease were negative. The urine was normal.Operation.-Because of the typical appearance of the cyst the case was diagnosed as one of bilateral Cysticercus, and the worse (right) eye was operated on first to confirm the diagnosis. After two unsuccessful attempts a third operation was performed under local anaesthesia. A 5-mm. meridianal incision was made at 8 o'clock, 17 mm. from the limbus. The wound was retracted with two double hooks in the hope that the cyst would extrude, but as this did not happen it was assumed that the organism was dead and a lens spoon was gently inserted to scoop it out. As the spoon was inserted there was much bleeding from the choroid, so that the spoon had to be withdrawn and the wound mopped up. Suddenly the edge of a white mass presented itself, and this was gently pulled out with Arruga's forceps (Fig. 1, opposite). After the application of surface diathermy, the wound was closed.

Orbital and adnexal cysticercosis

“…Multiple cysts in one eye are rarely seen although a large number of Cysticerci are disseminated into the circulation during a single infection 21 . Similarly, bilateral involvement with this disease is infrequent 1,21,72 …”

“…21 Similarly, bilateral involvement with this disease is infrequent. 1,21,72 The manifestations of cysticercosis reflect two distinct processes: (i) the local inflammatory response induced by the parasite; and (ii) the local effect of the space-occupying lesions. The onset of symptoms also depends on the potential space at the site of cyst lodgement within the body, so irrespective of the stage of cyst evolution, the tighter and limited space of the orbit may lead to early onset of symptomatology merely due to a mass effect.…”

In-toto removal of a subretinal Cysticercus cellulosae by pars plana vitrectomy.

“…Subretinal parasites can be removed through a sclerotomy." 18 But this technique carries some risks. Extensive periocular surgery may be required to gain adequate exposure.…”