Ahmed Y. Hatata, MSc Rowayda M. Amin, MSc Assistant Lecturer Ophthalmology Alexandria University, Egypt Toxocariasis
History A 28 year old male patient complaining of diminution of vision in the right eye A 28 year old male patient complaining of diminution of vision in the right eye Medical history: free Medical history: free Surgical history: ureter stone surgery 2 months ago Surgical history: ureter stone surgery 2 months ago Family history: free Family history: free Drug 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 eosinophilia positive serology for toxocara antibodies (indirect ELISA IgG)
Diagnosis Toxocariasis induced Uveitis
Treatment no treatment due to granuloma outside of the fovea no systemic manifestations no 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