Clinical Picture

Eye can see a nest of worms!

Haotian Lin, Xiaoling Liang

In October, 2010, a 38-year-old woman presented with creeping sensation in her right eye, but without any systemic or visual symptoms. Her medical history was notable only for an unknown insect ying into her right eye during farm work about 3 months earlier. On examination, a live worm was seen moving out from the nasal upper eyelid of the right eye above the conjunctiva (gure A). This was further viewed with anterior segment optical coherence tomography (gure B). When proxymetacaine eye-drops were administered, preparing the eye for surgical exploration, more than two worms were seen moving (gure C, D). The worm nest in the superior-nasal subconjunctiva tissue
A

was completely cleared. The worms were all removed and identied as one female and two male Thelazia callipaeda. The creeping sensations resolved immediately, with no recurrence after 6-month follow-up. Thelazia callipaeda infects orbital cavities and associated tissues of man and other carnivores. Drosophila is its vector host, and it tends to infect individuals residing in poor communities in Asia, particularly in China.
Acknowledgments This report was funded by the National Natural Science Foundation of China (30973899 and 81000389). The funding source had no involvement in writing the report.

Lancet 2012; 379: e42 Published Online January 13, 2012 DOI:10.1016/S01406736(11)61455-4 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China (H Lin MD, X Liang MD) Correspondence to: Dr Xiaoling Liang, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, China liangxiaolingsums@yahoo. com.cn

Figure: Thelazia callipaeda (A) On initial examination one worm is seen; (B) optical coherence tomography; (C and D) two worms seen after eye-drops are administered.

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