Unilateral conjunctivitis of unique etiology: A case report from Eastern India

Abstract

A middle-aged female patient from West Bengal presented with complaints of redness, foreign body sensation, and watering for 2 days in the left eye. Slit lamp examination of the left eye revealed several minute white foreign bodies moving over the bulbar conjunctiva. Removal of the foreign bodies under local anesthesia, followed by microscopic examination, suggested the presence of first instar larvae of Oestrus ovis; the sheep nasal bot fly. Diagnosis of unilateral external ophthalmomyiasis was made. Such cases though very infrequently have been reported in the past from Southern and Central Part of India. To the best of our knowledge, this is the second report from Eastern India. A high index of suspicion is necessary both on the part of the clinician and the microbiologist for correct diagnosis.

Ophthalmomyiasis Externa and Importance of Risk Factors, Clinical Manifestations, and Diagnosis: Review of the Medical Literature

“…Clinicians must consider ophthalmomyiasis a possibility in patients exhibiting nonspecific symptoms, as demonstrated in this study and various others [26]. Failure to do so in endemic areas or tourists returning from such regions may lead to mistaking ophthalmomyiasis for other forms of conjunctivitis [30]. Symptoms typically resemble acute catarrhal conjunctivitis and include burning, stinging, itching, increased tearing, and the sensation of a foreign object in the eye [10].…”

“…India has experienced a substantial number of external ophthalmomyiasis cases over the last two decades, as evidenced by nine case series studies, with Misra [78], while in the other 22 reports, one or two cases were reported [2,13,20,29,30,[62][63][64][65][79][80][81][82][83][84][85][86][87]. The causative agents identified in India were O. ovis, Musca ssp., Musca domestica Linnaeus (Insecta: Diptera: Muscidae), and C. bezziana.…”

“…The symptoms of external ophthalmomyiasis are non-specific. Therefore, it can be misdiagnosed as any other type of acute viral or bacterial conjunctivitis if myiasis is not considered by clinicians [30]. In the case of O. ovis ophthalmomyiasis, the manifestations of human conjunctival myiasis are usually short-lived and self-limiting, as the larvae cannot develop further and die within 10 days [30].…”

“…It is of utmost importance to identify the species of flies involved, as some can cause substantial harm to deeper eye tissues and affect vision [3]. While viral and bacterial infections are the most common causes of red eyes, parasitic infestations can also lead to unilateral red eyes [30]. Therefore, external ophthalmomyiasis should be considered a possible cause of pink eye, even in healthy individuals residing in large cities [73], as approximately 15% of cases reported over the last two decades have occurred in healthy people with no history and living in large cities [47,49,96].…”

External Ophthalmomyiasis Caused by Oestrus Ovis (A Case Report)

“…Larvy Oestrus ovis však nejsou schopny vylučovat proteolytické enzymy, proto jsou většinou omezeny na vnější povrch oka [4]. V literatuře jsou uváděny vzácné případy komplikací jako jsou: podspojivkové krvácení (Obrázek 2), vřed rohovky, zhoršený zrak, intraokulární invaze s endoftalmitidou, iridocyklitida a dokonce slepota [5].…”