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Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 156-157

Commentary: Ophthalmic myiasis: Look before you leap!

Consultant Ophthalmologist Ocular Oncology and Oculoplastic Surgeon at O.P. Choudhary Hospital and Research Centre MS Ophthalmology (Gold Medalist), F.I.C.O, MRCSEd (UK)

Date of Web Publication20-Jan-2023

Correspondence Address:
Ankita Aishwarya
Room No. 206, MRA M2, SGPGI, Lucknow, Uttar Pradesh

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2265_22

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How to cite this article:
Aishwarya A. Commentary: Ophthalmic myiasis: Look before you leap!. Indian J Ophthalmol Case Rep 2023;3:156-7

How to cite this URL:
Aishwarya A. Commentary: Ophthalmic myiasis: Look before you leap!. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:156-7. Available from: https://www.ijoreports.in/text.asp?2023/3/1/156/368215

Ophthalmic myiasis or ophthalmomyiasis is an infestation of the eye by fly larvae and constitutes <5% of cases of human myiasis.[1] Various species causing ophthalmic myiasis include Oestrus ovis, Fannia, Musca domestica, Hypoderma tarandi, Dermatobia hominis, Chrysoma bezziana, and Cephenemyia trompe.[2],[3] Based on the site of infestation, they can be ophthalmic myiasis externa, which involves the ocular surface, or ophthalmic myiasis interna, which penetrates intra-ocularly, and orbital ophthalmic myiasis.[2],[4] Entomologically, they can be classified as specific or obligatory, which requires a living host for development, semi-specific or facultative, which can survive on both living and dead, and accidental or pseudomyiasis, where eggs are deposited accidentally.[4],[5] External ophthalmomyiasis is most commonly caused by Oestrus ovis, and Musca domestica is a rare cause.[4],[5] Cephenemyia trompe, Dermatobia hominis, Hypoderma tarandi, and Chrysoma bezziana are found to be responsible for ophthalmomyiasis interna.[3] Chrysomyia and Cordylobia are more dangerous as they can penetrate deep and can lead to globe destruction.[6]

Predisposing factors are chronic debilitating disease, farmers, poor hygiene, open wounds, malignancy, and ischemia but can be seen in healthy and immuno-competent individuals.[2],[5],[6] If left untreated, they can lead to orbital destruction, blindness, and even death.[2],[5] Considering the rarity, wide risk factors, and morbidity of the disease, prompt diagnosis and management are needed.

Mostly, the flies carry the larvae and deposit them on the ocular surface, leading to ophthalmic externa. However, in ophthalmic myiasis interna, the larvae secrete cephaloskeleton and proteolytic enzymes, which play an important role in ocular penetration.[2],[7]

They mostly present with a history of abrupt hitting of flies in the eye as was seen in this case,[8] foreign body sensation, watering, pain, itching, photopsia, swelling, or redness in the eye. External ophthalmic myiasis can present with signs of conjunctivitis, uveitis, and diffuse or nodular eyelid swelling.[2],[3],[4],[5],[6] These larvae tend to migrate to fornices; hence, an examination by double eversion of the eyelids is recommended. In ophthalmic myiasis interna, they can have floaters, vitritis, and subretinal tracks in a criss-cross pattern or even without any pattern, retinal detachment, or hemorrhages.[9] Orbital myiasis is dangerous and can cause orbital destruction within days.[5]

Management needs a multi-disciplinary team of ear, nose, and tongue (ENT) to rule out sinus and nose involvement and microbiology or entomologists for identification of the organism. Computed tomography (CT) scan of the brain, orbit, and paranasal sinuses is required in orbital myiasis to look at the extent of the lesion, bony involvement, and destruction of the tissue. The transport media for the retrieved larvae is 70% alcohol or 10% formalin.[3],[5] The ultimate treatment is the retrieval of the organism using fine non-toothed forceps. Mere saline wash will not be useful as these larvae have hooks that cling to the surface.

In external ophthalmic myiasis, the larvae are removed after instilling topical anesthesia with proparacaine hydrochloride 0.5% or xylocaine 0.4% or pilocarpine 1–4%.[3],[5] Complete examination of the ocular surface is performed along with a double eversion of the eyelid to look for the hidden larvae in fornices. Topical antibiotics and topical steroids are given to combat the inflammation. Even oral ivermectin (200 μg/kg)) and mebendazole have been used.[1],[2] Continuous follow-up for the first 3 days with a thorough examination of the ocular surface and fornices must be performed to avoid any larval surprise as was performed in this case report.[8]

In internal ophthalmic myiasis, treatment options include laser photo-coagulation, vitrectomy with larva removal, and co-administration of intra-ocular steroids.[9]

In orbital ophthalmic myiasis, the larvae can be immobilized by ether, topical proparacaine, turpentine oil packing, hydrogen peroxide, isopropyl alcohol, petroleum jelly, or liquid paraffin followed by manual removal of larvae.[2],[3],[4],[5],[6] Systematically, a single dose of ivermectin (200 μg/kg) and a tapering dose of oral steroids (1 mg/kg) should be started.[2],[3],[4],[5],[6] To avoid the intracranial extension in the case where the globe is penetrated, it is better to perform enucleation, and if adjoining bones or sinuses are involved, then exenteration is to be considered.[3],[4],[5],[6] Daily dressing of the wound and keen watch on additional larvae is important.

Although ophthalmic myiasis is a relatively rare condition, it can lead to blindness and even death if not diagnosed and treated well in time. A high index of suspicion is needed. Meticulous removal of all larvae along with double eversion of the eyelid is important to prevent penetration of the globe and intracranial extension, thus helping in vision, globe, and life salvage.

  References Top

Wakamatsu TH, Pierre-Filho PT. Ophthalmomyiasis externa caused by Dermatobia hominis: A successful treatment with oral ivermectin. Eye (Lond) 2006;20:1088-90.  Back to cited text no. 1
Pather S, Botha LM, Hale MJ, Jena-Stuart S. Ophthalmomyiasis externa: Case report of the clinicopathologic features. Int J Ophthalmic Pathol 2013;2:10.  Back to cited text no. 2
Rana R, Singh A, Pandurangan S, Gupta P, Udenia H, Agrawal A. Cryptic myiasis by chrysomya bezziana: A case report and literature review. Turk J Ophthalmol 2020;50:381-6.  Back to cited text no. 3
Naik VD, Usgaonkar UPS. Bilateral destructive ophthalmomyiasis: A rare case report. Int J Med Dent Sci 2021;11:2034-6.  Back to cited text no. 4
Khurana S, Biswal M, Bhatti HS, Pandav SS, Gupta A, Chatterjee SS, et al. Ophthalmomyiasis: Three cases from North India. Indian J Med Microbiol 2010;28:257-61.  Back to cited text no. 5
[PUBMED]  [Full text]  
Sachdev MS, Kumar H, Roop, Jain AK, Arora R, Dada VK. Destructive ocular myiasis in a noncompromised host. Indian J Ophthalmol 1990;38:184-6.  Back to cited text no. 6
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Kearney MS, Nilssen AC, Lyslo A, Syrdalen P, Dannevig L. Ophthalmomyiasis caused by the reindeer warble fly larva. J Clin Pathol 1991;44:276-84.  Back to cited text no. 7
Jha RK, Manoj GM, Kaushik J. Pseudo-ophthalmomyiasis externa due to Musca domestica (Housefly): A case report. Indian J Ophthalmol Case Rep 2023;3:154-6.  Back to cited text no. 8
  [Full text]  
Lagacé-Wiens PR, Dookeran R, Skinner S, Leicht R, Colwell DD, Galloway TD. Human ophthalmomyiasis interna caused by Hypoderma tarandi, Northern Canada. Emerg Infect Dis 2008;14:64-6.  Back to cited text no. 9


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