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| CASE REPORTS |
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| Year : 1992 | Volume
: 38
| Issue : 4 | Page : 200-1,198 |
Orbital cysticercosis.
SS Gadkari, SK Bhabha, RP Jehangir, SD Adrianwala, MV Kirtane, NA Shah
Dept of Opthalmology, Seth GS Medical College, Parel, Bombay, Maharashtra.
Correspondence Address:
S S Gadkari
Dept of Opthalmology, Seth GS Medical College, Parel, Bombay, Maharashtra.
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 0001307595 
Orbital cysticercosis is a rare condition. We report here 3 cases with orbital cysticercosis who presented with proptosis and ptosis (Case no. 1 and 2) and focal seizures (Case no. 3). All of them had a vision of 6/6. Diagnosis of cysticercosis was made on CT Scan. The lesions isolated in Cases 1 and 2 and were excised. Drug therapy was given to treat any persisting infestation. Case no 3 had multiple brain cysticerci in addition to the orbital one. However, the patient was lost to follow-up.
Keywords: Adolescent, Adult, Albendazole, therapeutic use,Case Report, Child, Combined Modality Therapy, Cysticercosis, complications,drug therapy,radiography,surgery,Diagnosis, Differential, Female, Human, Niclosamide, therapeutic use,Orbital Diseases, complications,drug therapy,radiography,surgery,Tomography, X-Ray Computed,
How to cite this article:
Gadkari S S, Bhabha S K, Jehangir R P, Adrianwala S D, Kirtane M V, Shah N A. Orbital cysticercosis. J Postgrad Med 1992;38:200-1,198 |
Cysticercus cellulosae involve subcutaneous tissues, eye, muscle and nervous system in that order of frequency. Although ocular cysticercosis is not uncommon, orbital cysticercosis is rare[1],[2]. We report three cases of this condition.
Case 1: A 16-year-old girl presented with right-sided non-axial proptosis and ptosis of 6 months' duration. On examination, her vision was 616. Ocular movements were normal and there was no diplopia. There was a 3mm ptosis with 7mrn of levator action. On direct ophthalmoscopy, disc swelling was present. CT scan showed a peripherally enhancing, thick-walled, cystic, extraconal lesion situated superomedially in the orbit.
Case 2: A 31-year-old woman presented with variable right-sided ptosis over the last six years and proptosis of a year's duration; occasional pain and redness were reported. On examination, her vision was 6/6. Minimal proptosis with 6mm of ptosis and levator action of 2mm were observed. Right superior rectus action was restricted; there was no diplopia, probably on account of the ptosis. CT scan revealed a 1.5cm peripherally enhancing cystic mass situated extraconally and superiorly in the right orbit (See [Figure:1])
Case 3: An 11-year-old child, who presented with focal seizures, was found to have a cysticercus subretinally, at the nasal mid-periphery on the right. Vision was 6/6, Real-time orbital sonography showed an additional cysticercus within the right medial rectus [Figure:2]. CT scan demonstrated this lesion and several brain cysticerci, in addition. Magnetic resonance imaging confirmed the presence of the latter on spin- echo T1 and T2 sequences; the orbital lesion was better visualized on CT, however.
The patients underwent pre-operative stool examinations, soft tissue X-rays of both thighs and brain CT (Cases 1 and 2) to define intestinal, muscular and intracranial parasitic infestation, respectively (all negative, excepting the last in Case 3). Cysticercaf serology was not available.
In view of the isolated nature of the lesions in Cases 1 and 2, their proximity to the optic nerve and the dangers of inflammation extending to the latter, they were excised. A medial subperiosteal orbital approach was used. Granulation tissue and the cysticercus delivered themselves through an incision in the overlying periosteum. Both patients' vision and external ocular movements were unchanged after surgery. Proptosis regressed over a period of six weeks; the ptosis was uncorrected, however. A teanifuge (niclosamide) and a eysticidal (albenclazole) were given to presumptively treat any persisting gut and soft tissue infestation, post- operatively. Case 3 was lost to follow-up and therefore remains unverified and untreated.
The differential diagnosis of such cystic orbital lesions include developmental cysts, parasitic cysts (Echinococcus, Coenurus, Cysticercus), haematic cysts, mucocele, simple cysts and abscesses. Notably, the orbit is a rare site for cysticercosis[3]; the common sites of ophthalmological interest being subconjunctival and subretinal[4],[5]. All our cases had cysts located posteriorly in the orbit; this is again uncommon, since most cysts are usually located anteriorly[2],[3],[4],[5]. Cases 1 and 3 were different from other reported cases in that there was no evidence of inflammation[2],[3]. An inflammatory response invariably accompanies cyst death and this may be detrimental to the optic nerve; excision may thus be the treatment of choice[1] in orbital cysticercosis.
| :: References | |  |
| 1. |
Rootman J. Diseases of the Orbit. A Multidisciplinary Approach. Philadelphia: J B Lippincott; 1988, pp 159-160.  |
| 2. | Duke-Elder S. System of Ophthalmology, vol 13, part 2. London: Henry Kimpton; 1974, pp 929-931. |
| 3. | DiLoreto DA, Kennedy RA, Neigel JM, Rootman J. Infestation of extraocular muscle by Cysticercus, cellulosae. Br J Ophthalmol 1990; 74:751-752. |
| 4. | Siva Reddy P, Satyendran OM. Ocular cysticercosis. Am J Ophthalmol 1964; 57:664-666. |
| 5. | Malik SRK, Gupta AK, Choudhry S. Ocular cysticercosis. Am J Ophthalmol 1968; 66:1168-1171.
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