Ahmed Y. Hatata, MScRowayda M. Amin, MSc
Assistant Lecturer OphthalmologyAlexandria University, Egypt
Toxocariasis
History A 28 year old male patient complaining of
diminution of vision in the right eye Medical history: free Surgical history: ureter stone surgery 2 months ago Family history: free Drug history: free
First Presentation - Ocular Examination
BCVA: 6/12 OD 6/6 OS Anterior segment:
Unremarkable OU Fundus:
O.S.: free O.D.: white epiretinal mass close to the fovea with a fibrous band connecting
it to the disc
First Presentation - FLA
Hyperfluorescent epiretinal mass with increasing fluorescence in late phases due to staining
Tortuous retinal vessels towards the mass due to fibrous tissue traction
Late pooling of the dye around the mass due to mild tractional retinal elevation
First Examination - OCT
First Presentation – Lab Findings
eosinophiliapositive serology for toxocara
antibodies (indirect ELISA IgG)
Diagnosis
Toxocariasis induced Uveitis
Treatment
no treatment due togranuloma outside of the foveano systemic manifestationsno signs of inflammation
close follow up did not show up again
Pathogenesis Caused by infestation with toxocara canis, a
common intestinal roundworm of dogs Infection occurs secondary to ingestion of food
contaminated with the ova shed in the dogs faeces
In the intestine the ova proliferate into larvae which penetrates the intestinal wall and spread to different organs like the eye
Ocular toxocariasis - 3 forms
Chronic endophthalmitis like picture Posterior pole granuloma Peripheral granuloma
Less common manifestations include: anterior uveitis, papillitis and localized vitreous abscess
Chronic endophthalmitis
Presentation: between 2 and 9 years of age with leukocoria, strabismus ant. Uveitis Vitritis peripheral retina and pars plana: dense grey white
exsudate similar to a snowbank Complications: TRD and cataract Prognosis: poor Treatment: periocular steroids, surgery
Peripheral granuloma
Presentation: during adult life with visual impairment from macular distortion or RD
if uncomplicated it may remain asymptomatic, or white hemispherical granuloma anterior to the equator in any quadrant of the fundus vitreous bands may extend from the lesion to the
post. pole causing dragging of the disc and straightening of the blood
vessels
Posterior pole granuloma Presentation: unilateral visual impairment
rounded yellow white solid granuloma one to two discs in diameter overlying the macula occasionally may involve the disc no uveitis
Complications: vascular distortions and exudations, subretinal haemorrhages and may be RD