Ocular toxocariasis: atypical clinical course

Abstract

A 17-year-old man presented to the emergency department with complaints of retro-orbital pain of the left eye and an altitudinal visual field defect for 2 weeks. Fundus examination revealed ipsilateral hyperaemic optic disc oedema, and the patient was admitted with the presumptive diagnosis of left optic neuritis. Subsequently, during follow-up, the patient developed a retinal granulomatous lesion in the superior temporal arcade with vitritis and fibrotic strands extending to the mid-periphery. Serum antibodies detection by ELISA and aqueous humour immunoblot were positive for Toxocara canis Medical therapy with albendazole and oral steroids was instituted with satisfactory results. One year later, a new macular lesion developed with consequent vision loss.

Keywords: macula; retina.

Figure 1

Dense vitritis, granulomatous lesion in the superior temporal retinal artery with vitreous strands extending to mid-periphery and smaller inferior retinal lesion.

Figure 2

Stable granulomatous lesion in the superior temporal retinal artery with adjacent vitreous strands.

Figure 3

New macular yellowish lesion with moderate vitreous inflammation (right). Optical coherence tomography images showing foveal hiper-reflective lesion affecting all retinal layers (left).

Figure 4

Persistent foveal pigmentary changes (right). Loss of subfoveal photoreceptors and external layers on optical coherence tomography (left).