Unusual presentation of orbital cysticercosis-ptosis, diminution of vision and medial rectus weakness: a case report

Abstract

Cysticercosis is the most common parasitic disease of the nervous system. The disease occurs when humans become the intermediate host in the life cycle of Taenia solium by ingesting its eggs from contaminated food. The most common sites of involvement of cysticerci are soft tissue, eye and central nervous system. Unusual location of the cysts may result in uncommon manifestations. Ocular cysticercosis can involve both the intraocular and extra ocular muscle. Extra ocular muscle cysticercosis is rare. We are reporting the unusual manifestation of ptosis, proptosis, diminution of vision and medial rectus palsy due to cysticercosis. The patient was successfully treated with systemic steroids and albendazole.

Ocular cysticercosis causing isolated ptosis: A rare presentation

“…[5,6] There are also reports of ptosis developing following involvement of the extraocular muscles. [7,8] In these studies, ptosis was associated with other symptoms, such as headache, proptosis, conjunctival congestion, and limitation of the eye movements. Our case is unique, as the patient presented with isolated painless progressive ptosis without any other associated clinical sign.…”

Disseminated neurocysticercosis presenting as isolated acute monocular painless vision loss

“…Within the orbit, the cysticercii involve the extraocular muscles and soft tissues. [5] Ocular cysticercii are intravitreal, subretinal, within the anterior chamber, or subconjunctival. Among patients with orbital and ocular cysticercosis, most common presentation is proptosis, followed by subconjunctival cyst, subretinal cyst, papilledema, atypical optic neuritis, lid nodule and lastly intraretinal cyst.…”

“…[3,4] This is associated with an intense inflammatory reaction, fibrosis, and progressive thickening of the leptomeninges at the base of the brain. [5] There is an obstruction of the CSF circulation, resulting in hydrocephalus and progressive intracranial hypertension. Inflammation of the meninges, cranial nerve involvement, chiasmatic syndrome, and cerebral infarcts secondary to vasculitis may develop.…”

Orbital Cysticercosis Presenting as Swelling in the Medial Canthus

“…Double vision (diplopia) occurs due to misalignment of the visual axes, and the pattern of image separation is the key to diagnosing which particular cranial nerve (and extraocular muscle) is involved. In 1830, Soemmering was the first person to report the case of ocular cysticercosis [4]. The most devastating intraocular location is intravitreous and subretina which leads to blindness in 3 to 5 years unless the parasite is surgically removed.…”

“…Extraocular muscle involvement is uncommon. All the extraocular muscles are involved in myocysticercosis; however medial rectus muscle is the most frequently involved extraocular muscle in cysticercosis [2,4]. Patients presenting with restricted ocular movement and inflammatory signs, extraocular muscle cysticercosis should be considered.…”