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A Technique for Capturing Migratory Periocular Worms: A Case Series and Review of Literature

Tse, Brian C. M.D.*; Siatkowski, Rhea M.D.; Tse, David T. M.D.

Ophthalmic Plastic & Reconstructive Surgery: September-October 2010 - Volume 26 - Issue 5 - p 323-326
doi: 10.1097/IOP.0b013e3181c563e9
Original Articles

Purpose: To describe the clinical presentation of migratory nematodes and to outline a simple strategy to ensure capture.

Methods: Retrospective case series.

Results: Two consecutive patients with suspected migratory nematodes were treated promptly by strategic placement of a pharmacological barrier in the forniceal conjunctiva using 1% lidocaine with epinephrine to block the routes of retreat and to immobilize the worms for controlled retrieval. Two live nematode worms, one subcutaneous dirofilaria and one subconjunctival Loa loa, were successfully removed.

Conclusions: A sense of urgency is conveyed to isolate the migratory worm while it is still visible and residing in a location for easy surgical removal. The retreat of the worm to the deeper, inaccessible orbit is prevented by strategic placement of a perimeter of anesthetic.

Strategic placement of infiltrative anesthesia to block the routes of retreat and to anesthetize a migratory nematode to ensure capture.

*University of Miami Miller School of Medicine, Miami, Florida; †Dean McGee Eye Institute, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma; and ‡Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.

Accepted for publication October 7, 2009.

The authors have no financial and proprietary interest to disclose.

Address correspondence and reprint requests to David T. Tse, M.D., Bascom Palmer Eye Institute, 900 N.W. 17th Street, Miami, FL 33136, U.S.A. E-mail:

©2010The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.