Surgical Management of Extraocular Muscle Cysticercosis Causing Optic Foramen Syndrome

Orbital apex syndrome secondary to myocysticercosis: A case report from Nepal

Introduction

Cysticercosis is caused by parasitic infestation mainly by the larval form of Taenia solium. Orbital cysticercosis may involve both the intraocular structures and orbit particularly the extraocular muscles. The clinical manifestations are caused mainly by the mass effect of the cyst in the initial period resulting in ocular motility restriction and proptosis and depends primarily on the site of the lesion.

Case presentation

Here we report a case of 27 years old male with orbital apex syndrome secondary to myocysticercosis.

Discussion

Orbital myocysticercosis often mimics various eye pathologies like as isolated nerve palsy, orbital pseudotumor, orbital cellulitis. Acute vision loss in a case of orbital cysticerosis is mainly due to compressive optic neuropathy due to cystic lesion of extra ocular muscle or by direct invasion of the optic nerve. In our case, MRI orbit revealed cysticercosis of lateral rectus at orbital apex where it compressed the optic nerve resulting compressive optic neuropathy. Albendazole along with steroid was used as the first-line treatment.

Conclusion

This case highlights that Orbital Apex Syndrome Secondary to Myocysticercosis is a rare and can lead to severe visual loss if not managed timely.

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Cysticercosis is serious health problem in many developing countries of Asia like Nepal.

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Orbital cysticersosis can be sight threatening so early diagnosis and intervention can prevent vision loss.

Orbital cysticercosis: clinical features and management outcomes

AIM

To describe the clinical and radiological features of orbital cysticercosis and its management outcome.

MATERIAL AND METHOD

A retrospective analysis of consecutive cases of orbital cysticercosis between January 2008 and January 2018. The management outcome was classified into good, fair, and poor depending upon the resolution of the clinical features and status of the cyst and scolex in the imaging studies.

RESULTS

A total of 61 patients with a mean age of 24.33± 31.04 years were included. The male: female ratio was 1.9:1. Pain, with or without prominence of the eye was the most common presenting symptom (n = 35, 57.4%). The mean duration of symptoms was 3.65 +/-8.56 months. Ocular motility restriction was the most common sign (n = 52, 85.2%). Fifty-five (90.16%) patients had myocysticercosis with inferior rectus being most commonly involved (n = 17, 27.9%), while 6 (9.83%) cases had orbital cysticercosis without any ocular muscle involvement. Four patients had compressive optic neuropathy. Subjectively, good clinical outcome was documented in 37 (60.65%), fair in 17 (27.87%) and poor in 7 (11.47%) patients. Objectively, imaging studies showed complete resolution of the cysticercosis lesion in 18 (45%), partial in 19 (47.5%), and no change in 3 (7.5%) patients.

CONCLUSION

A high index of suspicion and a thorough knowledge of the clinical and radiological features are necessary for the proper diagnosis and management of orbital cysticercosis. Medical management with oral albendazole combined with oral steroids leads to desired outcome in the majority.

Cysticercosis in ophthalmology

Cysticercosis is caused by Taenia solium, a cestode or tapeworm that preferentially affects the subcutaneous tissue, brain, muscle, and the eye. It is traditionally a disease of low socioeconomic regions, but large-scale population migration has made it a matter of global concern. Its ocular invasion is a potentially blinding disease. In the last two decades, there has been considerable discussion of cysticercosis; however, most comes from a limited number of case observations. Thus, to overcome this limitation, we summarize and analyse twenty years of medical literature (from 2000 to 2020) on cysticercosis in ophthalmology.