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Subconjunctival larva migrans caused by sparganum

Mukherjee, B MS; Biswas, J MS; Raman, M PhD

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Indian Journal of Ophthalmology: May–Jun 2007 - Volume 55 - Issue 3 - p 242-243
doi: 10.4103/0301-4738.31959
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Dear Editor,

Spargana are plerocecroid larvae of a tapeworm of the genus Spirometra. It is a rare parasitic ocular infestation. There are a few reports of ocular sparganosis involving the eyelids, conjunctiva and intraocular cavity.123

We report a case of ocular sparganosis presenting as a migrating subconjunctival mass.

A 30-year-old Asian Indian male presented with redness and swelling of his left eye since three days. He gave history of protrusion of the left eye associated with pain, redness and blurring of vision two months back. Computed tomography showed a diffuse mass lesion displacing the lateral rectus medially. He was treated elsewhere with oral steroids. He had relief of symptoms initially but the redness recurred. A repeat scan showed complete resolution of the lesion.

On examination his visual acuity was 20/20; N6 in both eyes. Ocular movements were full. Examination of the right eye was normal. In the left eye, there was localized conjunctival congestion inferonasally and a small elevated lesion in the inferonasal conjunctiva with slight yellowish discoloration [Fig. 1]. The rest of the anterior segment was normal. Fundoscopy was normal in both eyes. There was no proptosis or lymphadenopathy.

Figure 1
Figure 1:
Subconjunctival nodule with localized congestion (with arrow pointing to nodule)

On repeat examination, two days after the initial presentation, the mass was found to move slightly upwards from the previous position. Hemogram was normal. There was no eosinophilia. Systemic examination was also normal. Transconjunctival biopsy under local anesthesia was undertaken. Intraoperatively the conjunctiva and tenons were opened over the mass and a live, coiled worm was found. The worm was sent for identification and the conjunctiva was closed with 6-0 Vicryl interrupted sutures. The gross and microscopic examinations [Fig. 2A and B] revealed an ivory-white ribbon-like worm measuring 27 mm x 2.5 mm. Histopathological examination showed that the anterior end was broad and contained a groove called bothrium. Scolex or true organs were not seen. The gross and microscopic examination revealed the larva to be sparganum. On last follow-up after a week, the patient was symptomless and conjunctival wound was healthy.

Figure 2A
Figure 2A:
Gross specimen of the worm after removal
Figure 2B
Figure 2B:
Photomicrograph showing the anterior end of the parasite Sparganum (magnification x40)

Humans can be the second intermediate or paratenic hosts. When sparganosis is contracted by drinking water infected with primary hosts (copepods of genus Cyclops), man acts as the second intermediate host. In the far East, infections are generally acquired by eating raw or partially cooked meat of infected snakes, frogs or mammals; or by applying raw infected flesh as a poultice to wounds. Here, man acts as paratenic host.4 In this case, the larva may have migrated from the lateral orbit to the inferonasal subconjunctival area in the course of two months. The definitive diagnosis and treatment of sparganosis are by surgical removal and identification of the parasite. No medication has been proven effective against sparganum.5

To the best of our knowledge, this is the first case of subconjunctival sparganum to be reported from the Indian subcontinent.

1. Kittiponghansa S, Tesana S, Ritch R. Ocular sparganosis: A cause of subconjunctival tumor and deafness Trop Med Parasitol. 1988;39:247–8
2. Yoon KC, Seo MS, Park Sw, Park YG. Eyelid sparganosis Am J Ophthalmol. 2004;138:873–5
3. Sen DK, Muller R, Gupta VP, Chilana JS. Cerstode larva (sparganum) in the anterior chamber of the eye Trop Geogr Med. 1989;41:270–3
4. Colour atlas /text of Ophthalmic Parasitology by Kean BH, Sun T, Ellsworth RM. 1991 New York IGAKU-SHOIN Medical Publishers Inc:195–200
5. Torres JR, Noya OO, Noya BA, Mouliniere R, Martinez E. Treatment of proliferative sparganosis with mebendazole and praziquantel Trans R Soc trop Med Hyg. 1981;75:846–7
© 2007 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow