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Intriguing Images

Migration of a Worm “The Last Dance”

Shrestha, Varun MD; Bajgai, Priya MD; Sahu, Sabin MD; Singh, Simar Rajan MS

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Asia-Pacific Journal of Ophthalmology: March-April 2022 - Volume 11 - Issue 2 - p 209-210
doi: 10.1097/APO.0000000000000429
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A30-year-old female came with complaints of decreased vision in the left eye for 1 month. On examination, she had best-corrected visual acuity 6/6 in the right eye and 6/18 in the left eye. On fundus evaluation, she had a localized subhyaloid hemorrhage just superior to the disc. We could visualize a glistening white live worm which further increased its wriggling movement on exposure to the light of the slitlamp. The worm was located in the preretinal space (Fig. 1).

F1
Figure 1:
Fundus photographs of the left eye showing a localized subhyaloid hemorrhage superior to the disc (A) denoting the probable site of entry of the worm (see arrows) into the vitreous cavity with the worm visible at various locations along the periphery in the same space (B-D).

We planned for a vitrectomy with the aspiration of worm along with laboratory tests including stool examination and CT-scan of the head and orbits. However, on the day of surgery, the worm had shifted to the subretinal space—which it probably did through near the area of the disc, as suggested by the localized hemorrhage. Thus, at this stage, we changed the course of management and performed a laser to confine and kill the worm. The patient was also treated with oral steroids and albendazole tablets. In our case, the worm had not caused any features of retinitis, choroiditis, retinal pigment epithelium defects, or any foveal damage (no features of diffuse unilateral subacute neuroretinitis)1,2 (Fig. 2).

F2
Figure 2:
Migration of the worm back to the subretinal space (A, B) as seen by vessels crossing over the worm. Laser has been done on and around the worm for its confinement (C, D). Post 1-month of laser, scarring around the area of the worm as evidenced by retinal pigment epithelium alterations but no evidence of obvious inflammation (E, F).

REFERENCES

[1]. Myint K, Sahay R, Mon S, et al. Worm in the eye: the rationale for treatment of DUSN in south India. Br J Ophthalmol 2006;90(9):1125–1127.
[2]. Padhi TR, Das S, Sharma S. Ocular parasitoses: a comprehensive review. Surv of Ophthalmol 2017;62:161–189.
Copyright © 2022 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.