WORM IN THE EYE : A RARE CASE OF LARGE SUBCONJUNCTIVAL ADULT LOA LOA WORM AND ITS MANAGEMENT

To illustrate a rare case of subconjunctival adult LOA LOA worm and its management. The patient was on a regular post cataract followup , when presented with complains of localised congestion and irritation on temporal conjunctiva. A large worm was spotted in the subconjuctival area with localised congestion.

Saatvik eye hospital, Vadodara, India 

The case was of 50 year old female, indian orgin with no past history of travel and a strict vgean diet. On diagnosis, the patient was immediately taken for surgery.  After instilling proparacain drops ,a  localised injection of preservative free 1% lidocaine with epinephrine was given in subconjuntival space housing the worm, with a dual aim of locally anaethetising the conjunctiva and to block the return movement of the worm by partially paralysing it. A small 2 mm incicison was made and the worm was isolate in the subconjuctival space. The worm was removed atraumatically using a blunt forceps. 

Post one week, the patient showed a total healing of local wound with total resolution of the localized vascular injection. The vision maintained to 6/9 on snellens and the patient had no futher complains of irritation. Histopathology of the specific confirmed the worm to be adult Loa Loa worm. The blood work of the patient was otherwise normal except for a mild eosiniophilia.  The patient was put on topical moxiflxacin four times a day with prenisolone drops four times , tapering, as local post operative therapy. She was put on oral diethylcarbamazine (DEC) 10mg/kg thrice a day for 3 weeks as systemic prophylaxis.  The patient was totally asymptomatic 4 weeks post operatively. 

Adult loa loa worm is normally migratory in nature and usually migtrates in the night time. A large worm of this size needs immediate surgical excision with a systemic treatment for other potential worms. The case though described, is rare , and reinforces the occurance of ocular parasitosis in indian population.