Ophthalmomyiasis externa: A case report from Alkharj, Saudi Arabia

Ophthalmomyiasis Externa: A Case Report in a Tertiary Care Center in Riyadh, Saudi Arabia

Introduction

Ophthalmomyiasis externa, which is caused by Oestrus ovis larvae, is a parasitic eye infestation that is prevalent in tropical and subtropical regions. It occurs in rural settings and is associated with risk factors, such as poor sanitation and underlying health conditions. Reports on this disease in Saudi Arabia are rare.

Case Presentation

A 30-year-old man from a rural area in Riyadh presented with severe left eye irritation and redness after being hit by an insect. Examination revealed seven motile larvae, which were identified as O. ovis, on the conjunctiva. The larvae were mechanically removed, and the patient was treated with topical antibiotics. On follow-up, four additional larvae were found and removed. Symptoms resolved completely, with no further larvae detected on subsequent follow-up.

Conclusion

Thorough history and examination are essential for the diagnosis of ophthalmomyiasis, especially in rural areas. Early detection and intervention are vital to prevent serious complications. This case highlighted the importance of awareness among healthcare providers.

Ophthalmomyiasis Externa and Importance of Risk Factors, Clinical Manifestations, and Diagnosis: Review of the Medical Literature

OBJECTIVE

This review aims to describe and compare the risk factors, clinical course, diagnosis, and parasitologic features of external ophthalmomyiasis. We also discuss the different preventive measures and the effect of global warming in a large case series reported from January 2000 to December 2022.

METHODS

We perform a literature review of reported cases of external ophthalmomyiasis to determine the clinical characteristics, therapeutic management, and information on the organisms that most commonly cause external ophthalmomyiasis.

RESULTS

A total of 312 cases of external ophthalmomyiasis were recorded. The most common causative organism was Oestrus ovis (Linnaeus) (Diptera: Oestridae), accounting for 72.1% of cases, followed by Dermatobia hominis (Linnaeus Jr. in Pallas, 1781) (Diptera: Oestridae) at 5.4%, Lucilia sericata (Meigen) (Diptera: Calliphoridae) at 0.96%, and Chrysomyia bezziana (Villeneuve) (Diptera: Calliphoridae) at 0.96%. Before experiencing symptoms, 43.6% of cases reported having direct contact with flies or being hit in the eye, 33% reported no associated risk factors, 9.3% reported living with sheep and goats, and 7.7% reported a history of foreign objects entering the eye. The most common symptoms for those affected by O. ovis were sudden onset, including a foreign body sensation and movement, redness, tearing, itching, swelling, irritation, photophobia, burning, and ocular secretion. In cases caused by D. hominis, symptoms included eyelid edema, pain, redness, itching, movement within the lesion, ocular irritation, and discharge. Regarding occupational or recreational activity, agriculture, and livestock had the highest incidence, followed by trades and technical activities, being a student, and having traveled to an endemic region for work or recreation.

CONCLUSION

Patients with red eyes may suffer from external ophthalmomyiasis, which requires a thorough examination to diagnose and treat it early. Moreover, as the temperature increases due to climate change, it is essential to consider how this will affect the spread of different pathogens.

A case of facultative ophthalmomyiasis externa due to Calliphoridae and review of the literature

Purpose

To describe a case of bilateral facultative ophthalmomyiasis externa due to Calliphoridae in a 30-year-old male assault victim at a suburban hospital in New York and review the relevant literature.

Observations

An adult male was found to have maggot infestation of both eyes and severe secondary injury to the left cornea and ocular surface. He was treated with manual larvae removal, oral ivermectin, broad spectrum IV antibiotics, and topical antibiotics. Anterior segment reconstruction was required.

Conclusions and importance

We report the first case of ophthalmomyiasis due to Calliphoridae in the United States and document the vision threatening potential of this rare condition. Timely examination by an ophthalmologist with early debridement may help prevent vision-threatening sequelae.

Morphological and Molecular Identification of Oestrus ovis (Diptera: Oestridae) Larvae Collected from a Chinese Patient with Conjunctival Myiasis

PURPOSE

Human conjunctival myiasis, which is often misdiagnosed or missed clinically, is commonly caused by Oestrus ovis larvae. Here, pathogenic identification was performed for two maggots collected from a patient from China, to provide a clinical scientific basis for diagnosis and treatment.

METHODS

Morphological identification was performed using a microscope. Oestrus mtDNA cox1 and rDNA 28S were selected as target genes for duplex PCR amplification, followed by cloning, sequencing, and identification.

RESULTS

Morphological examination showed that the maggots were approximately 1.0-1.5 mm long, long-oval-shaped, segmented, and covered with small spines, with a pair of hooks in the scolex and claw-like spines at the telson. Therefore, they were identified as the first-instar larvae of O. ovis. Duplex PCR detected products of approximately 400 and 200 bp, consistent with the size of designed cox1 and 28S D7a gene fragments, respectively. Sequences of cox1 and 28S D7a from the samples in question had 99.5-100.0% and 96.2-100.0% similarity (respectively) to GenBank sequences of O. ovis specimens known to parasitize sheep, goats, and humans. However, some 28S D7a sequences exhibited 89.7-90.6% similarity to GenBank sequences of Oestrus sp. known to parasitize Capra pyrenaica (Artiodactyla: Bovidae) (Iberian ibex). Therefore, we considered that the larvae infecting the patient originated from sheep or goats, not Iberian ibex. The phylogenetic trees supported this conclusion.

CONCLUSION

This study implemented the first duplex PCR molecular identification of O. ovis larvae parasitizing human eyes in China as a complementary approach to morphological identification. Our results indicate that molecular tools can be utilized to aid in the diagnosis of opthalmomyiasis.

In vitro larvicidal activity of ivermectin and povidone-iodine against Oestrus ovis

Purpose

To assess the in vitro larvicidal activity of ivermectin and povidone-iodine (PVP-I) against Oestrus ovis, the most frequent cause of external ophthalmomyiasis.

Methods

L1 O. ovis larvae were collected from the nasal boots of sheep slaughtered in local abattoirs and transferred onto Petri dishes containing mucosal tissue (25 larvae/dish). The larvicidal activity of the following formulations was tested: 1% ivermectin suspension in balanced sterile saline solution (BSSS), 1% ivermectin solution in propylene glycol, propylene glycol, 0.6% PVP-I in hyaluronic acid vehicle (IODIM®), and combination of ivermectin 1% solution and 0.6% PVP-I. One mL of each formulation was added to different Petri dishes containing the larvae. The time needed to kill the larvae was recorded.

Results

893 larvae were tested. The median time needed to kill the larvae was 46, 44, 11, 6, and 10 minutes for Iodim®, ivermectin 1% suspension, propylene glycol, ivermectin 1% solution, and a combination of ivermectin 1% solution with 0.6% PVP-I, respectively. Kaplan-Meyer analysis disclosed that the survival curves were significantly lower in samples treated with ivermectin 1% solution, ivermectin 1% solution + 0.6% PVP-I, and propylene glycol than in samples receiving other treatments or BSSS.

Conclusion

In this in vitro study, ivermectin 1% solution in propylene glycol, ivermectin 1% solution + 0.6% PVP-I, and propylene glycol alone showed a good, relatively rapid larvicidal activity against O. ovis larvae. Further experimental and clinical studies are necessary to establish whether, or not, these formulations may be considered as potential candidates for the topical treatment for external ophthalmomyiasis caused by O. ovis.

Ophthalmomyiasis externa: A case report

Ophthalmomyiasis is the infestation of ocular structures by fly larvae (maggots). Oestrus ovis is common among them. This is usually observed in rural areas, but a case presented here is from the urban areas. Depending on the species of larvae and ocular structure involved, manifestations vary from self-limiting condition to optic nerve involvement which may lead to blindness, and hence, identification and prompt management is necessary. This case report alerts the ophthalmologists from the urban areas to consider time management and also microbiologists for rapid identification.

EXTERNAL OPHTHALMOMYIASIS CAUSED BY OESTRUS OVIS (A CASE REPORT)

The work deals with atypical conjunctival infection of Czech patient with Oestrus ovis larvae. Ophthalmomyiasis is infestation of mammalian eyes by the larvae or worms of some flies. The most common cause of human myiasis is the Sheep. Shepherds are infected in habitats, but human eye disease outside the areas of abundant hamsters is rare. We describe a case of eye disease in a middle-aged man from the Czech Republic who spent a summer holiday seven weeks before examination in the north of Greece. During the first examination he was completely treated and no further problems were reported. Ophthalmomyiasis externa should be considered as a possible infection of travelers to the southern endemic regions when returning with an acute causeless onset of a one-sided foreign body sensation in the eye.