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Ophthalmomyiasis post craniotomy: a case report
First Author: A. Kacholia INDIA
Co Author(s): P. Sharma R. Sharma N. Jhamb
Ophthalmomyiasis is usually seen in necrotic tissue like basal cell carcinoma or in immunocompromised patients. We report a rare case of ophthalmomyiasis in a healthy patient with no such predisposing factors.
A 45 yrs. old female underwent craniotomy and tumor decompression for petrous bone meningioma which led to right iatrogenic facial nerve palsy and lagophthalmos. A temporary, paramedian tarsorrhaphy was performed to prevent exposure keratopathy.
Patient presented with gradually increasing pain in the right eye. No perception of light in the right eye, left eye was 6/6. On local examination, a large ulcer 4�3 cm involving the right upper and lower lids with blood-stained, foul smelling discharge. The suture of tarsorrhaphy had given way. Numerous wriggling maggots seen on the ulcer base , coming out of palpebral aperture. The details of eye not visible as covered with numerous maggots. Left Eye normal .CT scan of head, orbit and paranasal sinuses revealed no bony destruction or intracranial extension. A diagnosis of right eye ophthalmomyiasis was made.
Mechanical removal of maggots was done under topical anaesthesia with 4% Xylocaine. About 150 maggots were removed mechanically with forceps. The maggots offered great resistance to removal as they were adhered firmly to the underlying tissue. Turpentine oil applied to bring the deeper larvae onto the surface. Removal of the maggots revealed perforated cornea with destructed upper and lower lids. The wound cleaned with povidone iodine. Daily dressing with a course of oral , topical antibiotics done. Eye went into phthisis. The maggots were identified as Phylum Arthropoda, Class Insects, Order Diptera, Suborder Cyclorrhapha, Family Calliphoridae, Genus Chrysomyia
Ophthalmomyiasis is an uncommon condition. Very few cases have been reported in the literature and human infestation with Family Calliphoridae, as seen in this case, is extremely rare. Also ophthalmomyiasis is generally seen in immunocompromised patients or in necrotic tissue. This is possibly, a singular reported case of ophthalmomyiasis occuring in a healthy individual after tarsorrhaphy. We recommend regular follow-up and maintenance of hygiene in patients who have undergone tarsorraphy. Early diagnosis and treatment of myiasis can not only alleviate the patient�s symptoms, save the organ, but also inhibit the migration of flies in region where they are not endemic.
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