Introduction

Ocular parasitology is the study of parasites that infect humans and cause
complications in the eyes. The parasite is a living organism which, through its
intimate contact with another living organism, acquires some of its basic
nutritional needs. They are either simple one-cell protozoa or multicellular
metazoa complex. Protozoan parasite of ocular importance is toxoplasmosis, but
metazoan includes helminths such as Nemathelminthes (round-worms) and
Platyhelminthes (flatworms) which divided into cestodes (tape-worms) and
trematodes (flukes).
1. Protozoa:

A. Toxoplasma gondii: [Figure No.1]

Life-cycle:

It’s a protozoan parasite. Cysts are ingested by humans in cat feces or

meat and differentiate in the gut into forms that invade the gut wall. They infect
macrophages and form trophozoites, which rapidly multiply, kill cells, and infect
other cells. Cysts which contain bradyzoites later form. Cat ingests cysts in raw
meat and exists, multiplies, and forms gametocytes of both male and female
bradyzoites. This fuse to form oocysts in cat gut, which are excreted in cat feces.

Transmission:

It represents the commonest cause of uveitis worldwide. Human infection

occurs through the ingestion of food or water contaminated with cat faeces.
Toxoplasmosis may be acquired at any age but most commonly during childhood.
(Nimir et al., 2012). Cat is a definite host; intermediate hosts are humans and other
mammals.

Clinical finding:

Congenital ocular toxoplasmosis may include strabismus, nystagmus, and

blindness. The acute, acquired disease is associated with scotoma, photophobia,
and loss of central vision due to macular involvement. Oculomotor nerve
involvement may result in ptosis. (Klotz et al., 2000)

Diagnosis:

Serological tests are usually used for IgM and IgG antibodies. Visible in
tissue, trophozoites or cysts. First-line treatment is clindamycin and azithromycin.

B. Acanthamoeba spp.: [Figure No.2]

Characteristic:

“are ubiquitous free-living protozoa that have been isolated from several
habitats, including soil, bottled water, eyewash stations, and air.

There are two stages in the life cycle of this environmental ameba: the
motile trophozoite (8–40 μm) and the dormant cyst (8–29 μm). By encysting,
Acanthamoeba spp. can evade extreme environmental conditions such as
hyperosmolarity, glucose starvation, desiccation, extreme temperatures, and
extreme pH. “(Nimir et al., 2012)

Clinical finding:

“ocular disease due to involves direct contact between cornea and

trophozoites. Corneal injury is a predisposing factor and may be due to contact
lenses or corneal surgery. Contact lens solutions made from tap water have been
found to harbor microorganisms. Symptoms are generally quite protracted and
include severe pain, conjunctival edema, and loss of vision. Examination findings
include a ring infiltrate around the cornea, with possible corneal penetration.
Hypopyon, hyphema, and uveitis may be present as well. Histologic examination
demonstrates the presence of both trophozoites and cysts in the cornea.”(Klotz et
al., 2000)

Diagnosis:

Definitive diagnosis requires polymerase chain reaction of the

acanthamoeba deoxyribonucleic acid. Trophozoites and cysts can be identified in
Giemsa or periodic-acid-Schiff-stained smears from corneal biopsy specimens. The
culture requires growth on a bacterially seeded nutrient agar plate.

Treatment:

Hard and disappointing. In only a few cases, long term topical application
of agents such as propamidine, miconazole, and neomycin was successful.

C. Other protozoa:

- Trypanosoma cruzi
- Giardia lamblia
- Leishmania spp
2. Metazoa:

I. Nemathelminthes:

A. Loa loa: [Figure No.3]

Life-cycle:

The deer fly, Chrysops bite infects humans, which deposits infectious
larvae on the skin. Larvae enter the wound of the bite, wander through the body,
and develop into adults. Microfilariae released by females entering the blood
especially during the day. During a blood meal, microfilariae are taken up by fly
and differentiated into infectious larvae, which continue cycling when the next
person bites the fly.

Clinical finding:

Iridocyclitis associated with cloudy aqueous, vitreous opacities, and

raised intraocular pressure. There have been reports of posterior segment
involvement. Extensive hemorrhagic lesions associated with retinal detachment,
retinal neovascularization, vitreous hemorrhage, and subretinal exudates are seen.
The presence of multiple yellow exudates throughout the retina and occluded
arterioles have also been reported. Other systemic manifestations include
nephropathy, cardiomyopathy, lymphangitis, peripheral neuropathy, and
encephalopathy. (Das et al., 2016)
 Diagnosis:

Made in a blood smear by visualizing the microfilariae. No useful

serological tests.

Treatment:

Diethylcarbamazine eradicates the microfilariae and the adults may die.

Worms can require surgical excision in the eyes.

B. Other nematodes:

- Onchocerca volvulus
- Toxocara canis
- Dirofilaria repens

II. Platyhelminthses:

A. Taenia solium: [Figure No.3]

Life cycle:
 Humans ingest cysticerci-containing uncooked pork. Larvae attach to the
gut wall and develop into gravid proglottid adult worms. Terminal proglottids are
detached, passed into feces, and eaten by pigs. In the intestine, oncosphere
embryos burrow into blood vessels and migrate to the skeletal muscle, where they
develop into cysticerci. If humans eat T. solium eggs in food contaminated with
human feces, oncospheres burrow into blood vessels and spread to organs (e.g.,
brain, eyes) where they enjoy the formation of cysts.

Transmission:

Cysticercosis is only developed by the ingestion of eggs in fecally

contaminated food or water. Definitive hosts are human; intermediate hosts are
humans or pigs.

Clinical Finding:

Ocular involvement is well recognized and includes orbital, intraocular,

subretinal, and optic nerve lesions. Cysticercosis can be evident as a free-floating
cyst with amoeboid movements within the vitreous or anterior chamber of the eye.
Gaze palsies may also occur secondary to intramuscular cysts or cranial nerve
lesions from intracerebral cysts. (Nimir et al., 2012)

Diagnosis:

It depends on imaging with ultrasound, MRI, and CT scanning all being

useful, depending on the location of the cysts. (Chung et al., 2002)
 Treatment:

Albendazole. Anti-helminthic therapy can lead to an increased

inflammatory reaction around the lesions, which is why corticosteroids are
frequently used to treat neurological or ocular disease. Spontaneous cyst extrusion
from the orbit can occur, and when they grow and cause visual loss, surgery may
be required.

B. Other platyhelminthes:

- Echinococcus granulosus
- Fasciola hepatica
- S. mansoni

Conclusion:

Due to significant morbidity rates, ocular parasite infections are of medical

importance, and if not properly diagnosed and treated could result in vision loss.
Treatment depends on the causal organism and may require surgical removal
and/or antiparasitic treatment.