External ophthalmomyiasis manifesting with kerato-uveitis Published in International Ophthalmology Sonia Attia, MD Sana Khochtali, MD Nesrine Abroug, MD Moncef Khairallah, MD Department of ophthalmology Fattouma Bourguiba University Hospital Faculty of Medicine,University of Monastir Monastir, Tunisia

Ocular History A 77 year-old healthy man, living in a rural region Painful red, foreign body sensation and photophobia of the right eye of 4-days duration

First Presentation Visual acuity OD counting fingers, OS 20/63 Congested conjunctiva diffuse corneal edema associated with subepithelial numerous linear opacities 2+ aqueous flare and 1+ cells granulomatous corneal precipitates

First Presentation Intraocular pressure was normal bilaterally Bilateral nuclear sclerotic cataract Fundus examination was unremarkable in both eyes

Initial diagnosis and treatment A diagnosis of presumed herpetic keratouveitis was made The patient was treated with a combination of topical ganciclovir 5 times/ day and topical dexamethasone 6 times/day .

Follow-up One day later Slit lamp examination  an approximately 1-mm-long, translucent, light-sensitive, rapidly moving maggot on the conjunctiva, under the upper lid, and on the corneal surface

External Ophthalmomyiasis manifesting with Keratouveitis Final Diagnosis larvae of Oestrus ovis External Ophthalmomyiasis manifesting with Keratouveitis

Outcome Following removal of the maggot and instillation of tobramycin, the symptoms completely resolved within 2 days

Conclusion External ophthalmomyiais usually manifests with ocular surface involvement This diagnosis as an uncommon condition must be considered in the differential diagnosis of keratouveitis especially in rural areas