|
 |
| CASE REPORT |
|
| Year : 1992 | Volume
: 40
| Issue : 2 | Page : 59-60 |
|
Spontaneous extrusion of cysticercosis : Report of three cases
RK Bansal, Amod Gupta, SPS Grewal, Kanwar Mohan
Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh-160 012, India
Correspondence Address:
R K Bansal
Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh-160 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 1452285 
We report three cases of spontaneous extrusion of cysticercosis. In two cases, it got extruded from the orbit and in one case from the subconjunctival space. Extrusion of cysticercosis was associated with improvement in clinical signs and symptoms. Keywords: Cysticercosis, Spontaneous extrusion, Extraocular muscles, Subconjunctival space
How to cite this article:
Bansal R K, Gupta A, Grewal S, Mohan K. Spontaneous extrusion of cysticercosis : Report of three cases. Indian J Ophthalmol 1992;40:59-60 |
| Introduction | |  |
Ocular involvement in cysticercosis occurs in about 13 - 46% of the patients [1],[2],[3].Subconjunctival form of cysticercosis has been reported more commonly from India [1],[4],[5],[6] in contrast to intravitreal and subretinal forms of cysticercosis that have been reported more commonly from Western countries [1],[2],[10],[11]
Spontaneous extrusion of the cysticercosis from the subconjunctival space and orbit is rare [6],[9],[12]. We report three cases where cysticercosis got extruded spontaneously.
| Case report | | |
CASE No. 1
A 28 years old female presented with the history of recurrent attacks of pain and redness on the medial aspect of the left eye for the last six months. The last episode of pain and redness was associated with diplopia in the left lateral gaze. Examination showed a visual acuity of 6/6 in both eyes. The abduction was limited in the left eye. Conjunctival congestion was present over the insertion of the medial rectus muscle. A, CT scan showed a cystic mass in the medial rectus muscle near its insertion [Figure - 1]. Two weeks later, the cyst got extruded spontaneously from the medial aspect of the left eye leaving a gap in the overlying conjunctiva which healed spontaneously within ten days. The diplopia disappeared and ocular movements improved. Histopathology of the cyst confirmed the diagnosis of cysticercosis.
CASE NO 2
A 15 year old female presented with the history of pain and redness in her left eye for the last one month. She had noticed a swelling in the lower part of the left eye about 15 days back. This was associated with diplopia in upgaze. Examination showed a visual acuity of 6/6 in both eyes. Elevation was limited in the left eye. A cystic mass was present near the insertion of the inferior rectus muscle with hyperaemia of the overlying conjunctiva [Figure - 2]. Three days later, the cyst got extruded spontaneously leaving a small rent in the conjunctiva which healed within one week. The ocular movements improved and diplopia disappeared. Histopathology of the cyst confirmed the diagnosis of cysticercosis.
CASE NO 3
A 12 year old male boy presented with the history of diplopia for the last 15 days. The diplopia was more in dextro elevation. Examination revealed a visual acuity of 6/6 in both eyes. There was mild proptosis and ptosis of right upper lid. The eye ball was pushed a little down. Ocular movements were normal except for limited elevation. A cystic swelling was noted in the upper fornix near the insertion of the superior rectus muscle with congestion of the overlying conjunctiva. Computerised tomography showed a cystic mass in relation to the superior rectus muscle [Figure - 3]. A diagnosis of orbital pseudo tumour was considered but showed no response to a course of systemic prednisolone. Nine months later, he reported back with history of pus and discharge from the right upper fornix with extrusion of a small rounded cystic mass. He became asymptomatic after cyst extrusion. Now four months after the cyst extrusion, he has a minimum diplopia in dextroelevation. Ocular movements are normal. Repeat CT scan is normal.
| Discussion | | |
Ocular cysticercosis is not uncommon in North India[1],[7],[8], Majority of the cases reported from India had subconjunctival form of cysticercosis [1],[4],[6] though one report from North India found intraocular cysticercosis to be more common [7]. Since 1970, there are only three case reports of spontaneous extrusion of cysticercosis from the subconjunctival space[6],[9],[12] We report three such cases. In one of our patients (Case No 1), the cyst was located within the medial rectus muscle, in the second case, in the subconjunctival space and in the third case in the superior orbit from where they got extruded.
In orbital and subconjunctival cysticercosis, the cyst is usually attached to the muscle sheath [1],[5], where it induces inflammatory reaction and because of its constant motility it erodes through the conjunctiva and comes out leaving a rent in the conjunctiva which ultimately heals within a short period.
| References | | |
| 1. | Malik SRK. Gupta AK. Chaudhary S Ocular cysticercosis Am J Ophthalmol 66 1168-1171 1968  |
| 2. | Kruger Leite E, Jalkh AE, Quiroz H Scheppens; CL Intraocular cysticercosis Arn J Ophthalmol 99: 252-257 1985 |
| 3. | Spencer WH Ophthalmic Pathology 3rd ,ed WB Saunders 764.1985 |
| 4. | Reddy PS. Satyendran OM Ocular cysticercosis in India Am J Ophthalmol 57 664-666.1994. |
| 5. | Son DK. Mathur RN Thomas A Ocular cysticercosis, in India Brit J Ophthalmol 51-630-632-1967 |
| 6. | Reddy MV. Satvendran OM Sivaramakrishna K Spontaneous extrusion of subconjunctival cysticercosis; Acta Ophthalmalogica 48:321-324. 1970 |
| 7. | Jain IS. Dhir SP Chattopadhyay et al Ocu!ar cysticercosis Indian J. Ophlhalmol 77'54-561. 1976) |
| 8. | Sen DK Cysticercosis cellulosae in the lacrimal gland. orbit end eye lid Acta Ophthalmalogica : 58: 144-147, 1980) |
| 9. | Baskararajan G. Srinivasan A. Sivarama Zuleramanian P. Thivagarajan S Case of cysticercosis; presenting with persisiten diplopia and spontaneous extrusion Indian J Ophthalmal 28.219-220.1981 |
| 10. | Bartholomew PS Subretinal cysticercosis Am J Ophthalmol 79: 670-673: 1975. |
| 11. | Hutton WL Vaiser A. Svnder WB Pars plana vitrectomy for removal of intravitreous cysticercosis Am J Ophthalmol 81:571-573.1976 |
| 12. | Sud RN, Grewal SS Spontaneous expulsion of subconjunctival cysticercosis cellulose, Afro Asian J Ophthalmology 82-83. 1982 |
[Figure - 1], [Figure - 2], [Figure - 3]
| This article has been cited by | | 1 |
Orbital Cysticercosis: Clinical Manifestations, Diagnosis, Management, and Outcome |
|
| Rath, S., Honavar, S.G., Naik, M., Anand, R., Agarwal, B., Krishnaiah, S., Sekhar, G.C. | | Ophthalmology. 2010; 117(3): 600-605 | | [Pubmed] | | | 2 |
Spontaneous extrusion of subconjunctival cysticercosis |
|
| Reddy, B., Raj, A., Maurya, O.P.S. | | Annals of Ophthalmology. 2007; 39(3): 241-242 | | [Pubmed] | | | 3 |
Atypical presentations of orbital cysticercosis |
|
| Pushker, N., Chaturvedi, A., Balasubramanya, R., Bajaj, M.S., Kumar, N., Sony, P. | | Journal of Pediatric Ophthalmology and Strabismus. 2005; 42(5): 314-316 | | [Pubmed] | | | 4 |
Cysticercosis of superior oblique muscle: Surgical excision and reconstruction of superior oblique tendon |
|
| Bajaj, M.S., Pushker, N., Sen, S., Balasubramanya, R. | | Canadian Journal of Ophthalmology. 2002; 37(7): 423-426 | | [Pubmed] | | | 5 |
Photographic documentation of spontaneous extrusion of a subconjunctival cysticercus cyst |
|
| Raina, U.K., Jain, S., Arora, R., Mehta, D.K., Sharma, V. | | Clinical and Experimental Ophthalmology. 2002; 30(5): 361-162 | | [Pubmed] | | | 6 |
Orbital and adnexal cysticercosis |
|
| Pushker, N., Bajaj, M.S., Betharia, S.M. | | Clinical and Experimental Ophthalmology. 2002; 30(5): 322-333 | | [Pubmed] | | | 7 |
Spontaneous extrusion of subconjunctival cysticercus cellulosae [8] |
|
| Magu, S., Nada, M., Khurana, A.K., Chugh, J.P. | | British Journal of Ophthalmology. 2001; 85(1): 116-117 | | [Pubmed] | | | 8 |
Fungal and parasitic infections of the eye |
|
| Klotz, S.A., Penn, C.C., Negvesky, G.J., Butrus, S.I. | | Clinical Microbiology Reviews. 2000; 13(4): 662-685 | | [Pubmed] | | | 9 |
Cystic lesions of the extraocular muscles |
|
| Sekhar, G.C., Lemke, B.N., Singh, S.K. | | Ophthalmic Plastic and Reconstructive Surgery. 1996; 12(3): 199-205 | | [Pubmed] | |
|
 |
|
|
|
Search Pubmed for