A Nest of Worms in the Eye

      A 31-year-old woman complained of itchiness and foreign body sensation in the right eye for half a month, which got so unbearable that she visited our emergency room. She reported no systematic medical history and recalled that a tiny black unknown insect had flown into her eye 1 month ago. Her uncorrected visual acuity was 20/20 binocularly. Upon slit lamp examination, 2 whitish thread-like worms were discovered in the inferior-temporal conjunctival sac and more parasites were found in the superior-temporal conjunctival fornix (Figure A). After topical application of amethocaine eyedrops, a nest of 7 worms was removed with microsurgical biceps (Figure B). Severe folliculosis was seen in the palpebral conjunctiva (Figure C). The worms were identified as Thelazia callipaeda by the Parasitology Department. On light microscopic examination, we observed a distinctive scalariform buccal capsule (black arrow) in the head end, serrated cuticle with transverse striations (black arrowheads) and esophagus-intestine junction (white arrowhead) (Figure D). Tobramycin and dexamethasone eye drops were applied for 1 week. During 6 months’ follow-up, the patient’s symptoms were completely resolved and no recurrence of ocular inflammation or larvae was observed.
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