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Live intraocular worm causing multifocal choroiditis

Live intraocular worm causing multifocal choroiditis. Dr Mamta Agarwal Dr J Biswas. At presentation. 43 yr / F OD - C/O pain, redness & floaters x 1 week H/O decreased vision in right eye x 2 weeks Diagnosis - ? Retinal exudates with macular odema. Clinical findings.

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Live intraocular worm causing multifocal choroiditis

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  1. Live intraocular worm causing multifocal choroiditis Dr Mamta Agarwal Dr J Biswas

  2. At presentation • 43 yr / F • OD - C/O pain, redness & floaters x 1 week • H/O decreased vision in right eye x 2 weeks • Diagnosis - ? Retinal exudates with macular odema

  3. Clinical findings • BCVA OD – 6/12 OS – 6/6 • SLE • OD – Circumcorneal congestion Aqueous cells & flare 2+ A live , active vigorously moving thread like worm in the anterior chamber • OS - Normal

  4. Slit lamp photo OD

  5. Video

  6. Treatment • Surgical removal of the worm from the anterior chamber under local anesthesia • Microscope examination • Dirofilaria tenuis ( 27 mm x 0.5 mm )

  7. Fundus OD Multifocal choroiditis with RPE & chorioretinal scars in the periphery.

  8. Investigations • Normal • Total & differential leucocyte count • Peripheral blood smear • Urine & stool test

  9. Treatment • Diethyl carbamazine citrate (6mg/kg/day) given in two divided doses for 3 weeks.

  10. Follow up • After 1 month • BCVA OD – 6/6 • Fundus • OD - Healed choroiditis • OS - Normal

  11. Fundus OD

  12. Conclusion • Live intraocular worm may present as acute iridocyclitis with multifocal choroiditis without any systemic complaints. • Surgical removal of the worm and antibiotic therapy results in resolution of choroiditis & improvement in visual acuity.

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