Ahmed Y. Hatata, MSc Rowayda M. Amin, MSc Assistant Lecturer Ophthalmology Alexandria University,...

Ahmed Y. Hatata, MScRowayda M. Amin, MSc

Assistant Lecturer OphthalmologyAlexandria University, Egypt

Toxocariasis

History A 28 year old male patient complaining of

diminution of vision in the right eye Medical history: free Surgical history: ureter stone surgery 2 months ago Family history: free Drug history: free

First Presentation - Ocular Examination

BCVA: 6/12 OD 6/6 OS Anterior segment:

Unremarkable OU Fundus:

O.S.: free O.D.: white epiretinal mass close to the fovea with a fibrous band connecting

it to the disc

First Presentation - FLA

Hyperfluorescent epiretinal mass with increasing fluorescence in late phases due to staining

Tortuous retinal vessels towards the mass due to fibrous tissue traction

Late pooling of the dye around the mass due to mild tractional retinal elevation

First Examination - OCT

First Presentation – Lab Findings

eosinophiliapositive serology for toxocara

antibodies (indirect ELISA IgG)

Diagnosis

Toxocariasis induced Uveitis

Treatment

no treatment due togranuloma outside of the foveano systemic manifestationsno signs of inflammation

close follow up did not show up again

Pathogenesis Caused by infestation with toxocara canis, a

common intestinal roundworm of dogs Infection occurs secondary to ingestion of food

contaminated with the ova shed in the dogs faeces

In the intestine the ova proliferate into larvae which penetrates the intestinal wall and spread to different organs like the eye

Ocular toxocariasis - 3 forms

Chronic endophthalmitis like picture Posterior pole granuloma Peripheral granuloma

Less common manifestations include: anterior uveitis, papillitis and localized vitreous abscess

Chronic endophthalmitis

Presentation: between 2 and 9 years of age with leukocoria, strabismus ant. Uveitis Vitritis peripheral retina and pars plana: dense grey white

exsudate similar to a snowbank Complications: TRD and cataract Prognosis: poor Treatment: periocular steroids, surgery

Peripheral granuloma

Presentation: during adult life with visual impairment from macular distortion or RD

if uncomplicated it may remain asymptomatic, or white hemispherical granuloma anterior to the equator in any quadrant of the fundus vitreous bands may extend from the lesion to the

post. pole causing dragging of the disc and straightening of the blood

vessels

Posterior pole granuloma Presentation: unilateral visual impairment

rounded yellow white solid granuloma one to two discs in diameter overlying the macula occasionally may involve the disc no uveitis

Complications: vascular distortions and exudations, subretinal haemorrhages and may be RD