A Young Ophthalmologist’S Surprise Diagnosis: Not All Red Eyes Are Conjunctivitis
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR564 | Type: Poster | DOI: 10.82333/6n42-1m74
Authors: Dr Ema Trajkova* 1 , Prof. Dr Biljana Kostovska 2 , Dr Martina Sofronijevikj 3 , Dr Era Tateshi 4 , Dr Sumeja Ebibi Kasami 5 , Dr Ljuben Angelovski 1 , Dr Viktorija Shamovska - Petreska 6 , Dr Sara Blazhevska 7 , Prof. Dr Bekim Tateshi 8
1Sistina Ophthalmology, Promedika,Skopje ,North Macedonia, 2Sistina Ophthalmology, Promedika,Skopje ,North Macedonia;Faculty of medicine University Goce Delcev,Stip,North Macedonia, 3Sistina Ophthalmology,Skopje ,North Macedonia, 4City General hospital 8th September ,Skopje ,North Macedonia, 5Sistina Ophthalmology, Promedika,Kumanovo,North Macedonia, 6General Hospital with Extended activity Borka Taleski,Prilep,North Macedonia, 7University Eye Hospital Svjetlost,Zagreb,Croatia, 8University Eye Clinic Skopje,Skopje ,North Macedonia
Purpose
The purpose of this report is to emphasize the importance of differentiating between acute conjunctivitis and other red eye pathologies compared to External Ophtalmomyasis .
In addition, to highlight the importance of detailed exposure history and meticulous slit-lamp examination in patients presenting with acute red eye.
Setting
Tertiary ophthalmology referral center.
Methods
A 21-year-old female presented with itching, pain, redness, and lower eyelid swelling of the right eye. Symptoms began six hours after a fly entered the eye while camping. Ophthalmic examination included best-corrected visual acuity, slit-lamp biomicroscopy, eyelid eversion with fornix inspection, and dilated fundus examination to exclude intraocular involvement. Ophthalmomyiasis externa was diagnosed by visualization of motile larvae consistent with Oestrus ovis. Larvae were removed at the slit lamp under topical anesthesia (0.5% proparacaine) by mechanical extraction with sterile forceps, double eyelid eversion, and copious irrigation of the conjunctival sac. Extracted larvae were submitted for microbiological identification.
Results
At presentation, BCVA was 20/20 in both eyes. Slit-lamp examination showed conjunctival hyperemia and multiple motile translucent larvae in the superior and inferior fornices of right eye. Cornea had superficial punctate epithelial erosions without stromal involvement, and no anterior chamber reaction was observed. Fundus examination excluded intraocular involvement. A total of 22 larvae were removed with immediate symptom relief. Postoperatively, the patient received topical tobramycin, lubricants, and topical NSAIDs. At Day 1, hyperemia was reduced with no residual larvae. At Week 1, complete resolution was observed with stable visual acuity. No recurrence occurred during 1-month follow-up. Microbiological analysis confirmed Oestrus ovis.
Conclusions
Ophtalmomyasis can initially mimic acute conjunctivitis and remain undetected on routine examination . Detailed exposure history and comprehensive slit-lamp evaluation, including lid eversion and ocular irrigation are fundamental for accurate diagnosis.Immediate mechanical removal of larvae results with a complete clinical recovery , although transient corneal and conjunctival changes may be seen.