Pars plana vitrectomy performed after parasite spotted “moving sluggishly” in patient’s eye

Clinicians have described their treatment of a 35-year-old man who was found to have a gnathostoma spinigerum nematode in his eye.

Writing in The New England Journal of Medicine, the authors outlined how a patient presented to the All India Institute of Medical Sciences Bhopal in India reporting an eight-month history of redness and blurred vision in his left eye.

Further examination revealed that the patient’s left eye was bloodshot with a dilated, fixed pupil. His visual acuity in the affected eye was 6/24.

Fundoscopy revealed a worm “moving sluggishly” in the posterior segment. After a pars plana vitrectomy was performed to remove the worm, the parasite was examined through light microscopy.

The larval-stage nematode had a cephalic bulb, thick cuticle, and well-developed intestine – features that are consistent with gnathostoma spinigerum.

The clinicians came to a diagnosis of ocular gnathostomiasis. The parasitic infection is commonly associated with eating undercooked freshwater fish, poultry, snakes, or frogs.

The patient, who is from rural central India, reported consuming poultry and freshwater fish.

He was treated with oral and ocular glucocorticoid and albendazole. At a two-month follow up, the patient’s symptoms had resolved but his visual acuity remained 6/24 as the result of the development of a cataract.