Author: Damian Garcia-Teillard (Spain)
Co-authors: Ismael Molina, M Angeles Barranco, Antonio Domingo, Sol Guilloto, Javier Lavid De Los Mozos
Purpose
To describe the clinical course and main laboratory findings of a patient with Toxocara retinitis.
Setting/Venue
A 14 year old girl is referred to our ophtalmology unit from her paediatrician, complaining about blurred vision, diplopia and mild photophobia, without describing vision loss. On admission, there is no evidence of decreased visual acuity, yet signs of vitritis and retinal folds appear to be present on fundus exploration.
Methods
A report of the main clinical and laboratory findings on patient diagnosed with Toxocara retinits is performed. These are summarized and compared to a review of the literature on Toxocara infections.
Results
A case of a 14 year old girl with toxocara retinits is decribed. On admission, the patient complains of blurred vision and mild photophobia. No loss in vision reported Visual acuity on admission appears to be 1 for right eye, and 0’9 for left eye. No alterations of ocular extrinsic motility are shown. Anterior segment exploration appears to be normal for both eyes. Fundus exploration was normal for right eye, but showed vitritis and retinal folds on left eye, which are followed-up by OCT . Serologic testing was performed, which only showed to be positive for Toxocara IgG. As main treatment, oral prednisone 40mg once a day was given, in addition to Albendazole tablets 400mg every twelve hours. One week later, a retinitis focus appears at 12h on left eye fundus, associated to a vitreous traction and serous retinal detachment. Vitrectomy, and superior laser photocoagulation are performed, resulting in disappearance of traction and retinal detachment. After surgery, of retinal detachment, vitritis still persisted , yet milder, and was treated with oral prednisone, starting at 40mg/day and decreasing the dose for 3 months. On controls, vitritis finally disappeared, and the eye remains stable one year later, with no further membranous folds.
Conlusions
Toxocariasis are parasitic zoonosis, caused at larval stages1 of Toxocara canis or Toxocara cati, usually by fecal-oral route. Seroprevalence for human Toxocara ranges between 2 and 80%, with the highest prevalence in Japan, USA, and Argentina. Toxocara produces systemic infections1, yet, exclusive ocular infection is possible (0,1-1%), when caused by Ocular Larva Migrans, most common in kids, usually being asymptomatic or referring mild visual acuity loss. Ocular affection is less common in humans than animals. Most ocular Toxocara infections appear to be asymptomatic, and unilateral. More serious cases in children may lead to strabismus, leukocoria, or even severe immune response , causing, phthisis bulbi. Furthermore, development of retinal folds may lead to fatal retinal detachment if not suspected in advance. When it comes to ocular Toxocariasis, fundus examination remains a key step in order to assess the presence of posterior vitritis, in which case, the formation of membranous retinal folds must be suspected and evaluated, in order to prevent retinal detachment. Systemic treatment is performed with antihelminthic drugs such as Albendazol. Systemic steroids are needed when serious uveitis appears. But, surgical treatment remains the only and most important option when tractions appear leading to retinal detachment.
Financial Disclosure
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