Fulminant Orbital Myiasis - A Rare Case Report from Central India

Abstract

A 42 year old male farmer presented to eye OPD with a history of painful, foul smelling discharging wound over the lower lid along the inferior orbital margin since two weeks and crawling sensation over the wound with diminution of vision right eye since three days. He gave history of trauma to right eye after falling on sharp edge of stone one month back when he was in a drunken state due to which he had a lacerated wound of about 5cm x 2 cm x 2cm along inferior orbital margin.

The wound was cleaned and dressed only once at a local hospital, however, he neglected the wound and didn’t open the dressing for about next 15 days until he noticed a crawling sensation and maggots teeming from the wound. He denied a history of diabetes mellitus, hypertension or any other chronic systemic disease or any prolonged use of medications, progressive loss of weight or appetite. However, he was a chronic alcoholic. He belonged to low socioeconomic strata with poor personal hygiene and was residing in a rural area.

On presentation, the patient was in agony due to pain. On examination of the right eye, the eyelids were severely oedematous and indurated with severe mechanical ptosis.  The lower lid along the inferior orbital rim had a deep open, macerated wound of size about 5cm x 2cm x 2cm, filled with necrotic tissue (slough), discharge and around 5-6 maggots were seen teeming from the wound [Fig. 1]. The skin around the wound was red and friable. On separating the lids gently and mechanically, the conjunctiva was severely congested and chemosed. Unaided visual acuity was 3/60; best-corrected visual acuity could not be assessed as the patient was in agony due to pain. The cornea, anterior chamber and iris were normal.  The pupil was normal-sized reacting to light. The eyeball had deviated inwards and ocular movements were painful and restricted in all directions. Lens had immature senile cataract. Intraocular pressure and nasolacrimal passage could not be assessed because of gross lid oedema. Fundus examination of the right eye was within normal limits. On examination of the left eye, unaided visual acuity was 6/18 and best-corrected visual acuity was 6/9. Anterior segment was within normal limits with pupil normally reacting to light and fundus examination was normal.

Five to six superficially lying maggots were removed with the help of turpentine oil and forceps after adequate local anaesthesia. Many more deep-seated maggots were seen but were difficult to remove.