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River Blindness: The Value of an Ounce of Prevention

Patel, Avni V. BA; Lahey, Timothy P. MD, MMSc; Pepin, Susan M. MD

Infectious Diseases in Clinical Practice: May 2012 - Volume 20 - Issue 3 - p 216–218
doi: 10.1097/IPC.0b013e318234c4d9
Case Reports

Onchocerciasis arises from the transmission of Onchocerca volvulus, a parasitic worm, to humans by the Simulium black fly. Although the primary manifestation of onchocerciasis is dermatological, its most devastating consequences are in the eye. As microfilariae migrate through the eye, the inflammatory response invoked by their death results in the destruction of tissue, and this response, if left unchecked, may lead to severe visual impairment and blindness (“river blindness”). This case illustrates late manifestations of infection with O volvulus in a 21-year-old man who presented with long-standing bilateral vision loss. In doing so, the case should alert physicians to the possibility of onchocerciasis-related vision loss in people from endemic areas, and inform treatment considerations. In such patients, treatment may do little to improve vision but clearly helps eradicate parasitemia, thus preventing other manifestations of onchocerciasis. This case highlights the importance of effective prevention given the poor treatment options for those presenting with advanced eye disease, as well as the potential benefits of treatment in those with early onchocercal eye disease.

From the Dartmouth Medical School, Lebanon, NH.

Correspondence to: Avni Patel, BA, Dartmouth Medical School, 206 Kellogg Bldg, Lebanon, NH 03766. E-mail:

The authors have no funding to disclose.

The authors attest that there are no conflicts of interest with respect to themselves or the contents of this manuscript with any other authors or organizations. All 3 authors had full and equal access to the data used and presented in this manuscript, and each author contributed to the contents found within.

© 2012 Lippincott Williams & Wilkins, Inc.