Five fly larvae removed from patient’s conjunctiva

A man in his 20s who presented to hospital with symptoms mimicking conjunctivitis was found to have a “wandering organism” in his conjunctival fornix.

BMJ Case Reports authors described how the patient presented to the ophthalmology department at the All India Institute of Medical ScienceBhopal after experiencing a foreign body sensation in his right eye for the past three days.

He told clinicians that ‘dust’ had fallen into his eyes when he was riding his bike three days earlier.

A slit lamp examination of the affected eye revealed conjunctival congestion, particularly in the superotemporal region.

“Further evaluation of the conjunctival fornices showed a wandering organism, approximately 1mm by 2mm in size, white in colour, with speckled pigmentation and rapid vermiform movement,” the authors highlighted.

Anaesthetic drops were used to temporarily paralyse the larva and enable its removal using blunt forceps. Exploration with a surgical microscope revealed two more larvae, which were also removed.

Examination of the larva following removal confirmed that it was a first-stage Oestrus ovis (sheep nasal botfly) larva.

The patient started a two-week course of antibiotic and steroid eye drops, as well as a single oral dose of the antiparasitic agent, ivermectin.

During the treatment period, two more larvae were removed from the patient’s eye and sent for microbiological confirmation.

The patient reported a complete resolution of his symptoms at his two-week follow up appointment.

The clinicians highlighted that early recognition and treatment of the condition is crucial.

“Organisms can remain hidden in the conjunctival fornices and have the potential to multiply and invade deeper ocular tissues,” the authors wrote.

“This case highlights the significance of evaluating other differential diagnoses in individuals exhibiting symptoms of red eyes, beyond common conditions like conjunctivitis or episcleritis,” they concluded.