History of Presenting Illness
A 9-year-old healthy Indian boy presents with a complaint of blurred vision in his right eye (OD) for a week. He denied pain or floaters.
| OD | OS | |
|---|---|---|
| Visual acuity | 20/200 | 20/20 |
| Intraocular pressure (IOP) | 15 mm Hg | 14 mm Hg |
| Sclera/conjunctiva | White and quiet | White and quiet |
| Cornea | Clear | Clear |
| Anterior chamber (AC) | Normal depth and quiet | Normal depth and quiet |
| Iris | Normal | Normal |
| Lens | Clear | Clear |
| Anterior vitreous | Clear | Clear |
| Nerve: | Cup-to-disc (c/d) 0.2, normal |
| Macula: | Normal |
| Vessels: | Normal caliber and course |
| Periphery: | Unremarkable |
Questions to Ask
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Have you had any injury?
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Do you have a headache?
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Have you ever have any numbness, tingling, or weakness? Is there any history of prior neurologic disorders?
He answers no to all of these questions.
Assessment
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Intraocular cysticercosis with a scolex OD
Differential Diagnosis
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Intraocular cysticercosis OD
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Congenital retinal cysts OD
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Choroidal granuloma OD
Working Diagnosis
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Intraocular cysticercosis OD
Testing
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As this patient had a classic presentation of intraocular cysticercosis, namely visualization of a cyst and scolex with indirect ophthalmoscope, the diagnosis was confirmed on clinical examination. No further workup was necessary for intraocular involvement.
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However, ultrasound B scan is usually advised to rule out associated orbital lesions. No lesions were found.
Management
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Computed tomography (CT) brain to rule out central nervous system (CNS) involvement
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Pars plana vitrectomy OD to remove the intraocular cyst
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A posterior retinotomy was made outside the inferotemporal arcade close to the subretinal cystic mass.
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Mass was retrieved with subretinal forceps and removed en toto from the eye via one of the sclerotomies.
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Fluid–air exchange was performed, followed by laser around the retinotomy.
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Follow-up
The patient reported partial restoration of vision, with visual acuity (VA) improving to 20/80 OD ( Figs. 59.2 and 59.3 ). CT brain was negative for cystic lesions.
