ORBITAL MYIASIS

Presenting Author: Dr. Kshitij M ParekhResident, Dr. Vasantrao Pawar Medical College

Guide: Dr. Dhiraj BalwirAssociate Professor

Dr. Vasantrao Pawar Medical College

TITLE

A Rare Case Of Orbital Myiasis

PURPOSE

A maggot is the larva of a fly (order Diptera); most commonly the larvae of Brachyceran flies, such as houseflies, cheese flies, and blowflies.

‘Myia’ is a Greek word meaning ‘fly’. ‘Myiasis’ is a condition caused by infestation of the body by maggots. We report a case of orbital myiasis of the eyelid.

Ophthalmomyiasis progresses rapidly and can completely destroy orbital tissues within days.

It also destroys the bony tissues extending the infection to the brain.

METHOD

A female Hausabai Bhor, 75 years old with complaints of pain and feeling of some moving object in the left eye of 5 days duration.

One month before she had a history of dog bite on the left eye.

She did not receive any treatment prior.

On ocular examination  The patient was having visual acuity 6/9 in both eyes. She had a lacerated wound over both the eyelids of

the left eye. There was severe degree edema and derangement of

the anatomical configuration of upper eyelid. The wound was filled with pus. The nasal bridge was also damaged Lacrimal sac was missing. The conjunctiva was congested. Cornea showed mild edema. Ocular movements were normal. The right eye was normal

CT-scan reports showed intact bony walls of the left orbit.

Hemogram showed mild leucocytosis.

Surgical debridement under local anesthesia was done.

The larvae were removed with the help of forceps after instilling turpentine oil..

RESULT

The pus and exudates were cleared off till the healthy tissue was reached.

On removal of the pus from the wound the black headed larvae were seen.

Turpentine oil forced the aerobic larvae to surface for air, at which time they could be captured by forceps.

Utmost care was taken to remove each of the larvae completely so as to prevent foreign body reaction.

Additionally, lidocaine was injected into the floor of the cavity

After 3 days the wound was free of larvae and started healing.

Around 15-20 larvae were captured and the wound was filled with 10% povidine iodine solution.

Intravenous cefotaxime 1gm b.d. was started.

Tetanus immunization was done. Fresh granulation tissue started appearing.  The edema subsided gradually by the 7th day. There was complete resolution of the

oedema by the 15th day. The wound healed by secondary intention.

CONCLUSION

No delay should be done in case of treating the open wound and it should be covered to prevent access to flies.

 Wound should be properly managed post-operatively with antiseptic dressings and antibiotics..

There is no absolute method for protection against myiasis.

Adequate personal hygiene and proper care of wounds helps to a large extent in preventing this catastrophe.

Treatment of debilitating underlying conditions if any needs specific attention.