Presenting Author- Dr Ashok kumar PGT,Deptt of ophthalmology AMCH,Dibrugarh,Assam Principal Author-Dr Tapan Gogoi Assistant professor AMCH,Dibrugarh,Assam

Name-Mahesh mallik Age-30 yrs sex-male Address-morioni khatogodi T.E,Jorhat Hospital no.-312646/08 MRD no.-31652/08 Marital status-married Children -2, both male,4yr &8yr Occupation CTC machine driver OPD Visit-30-08 2008

Cond
CHEIF COMPLAINTS
Swelling &discomfort below left lower lid since 2 yr

HISTORY OF PRESENT ILLNESS:

Pt was asymptomatic till 2yr back when he noticed swelling below left lower lid,around a size of peas,not associated with pain,redness,itching,ocular movement restriction&diminution of vision.There was no h/o fever and any other swelling in body,no h/o of wt loss. He went to local doctor was prescribed some medicine, X-ray orbit was done (both AP &lateral ) and was found normal.After that swelling slowly increases in size and then subsides spontaneously with in 2 days.Since then swelling was on &off in nature.On august 25,2008,he went to some practitioner in jorhat and was referred to AMCH, dibrugarh.

COND

Personal history-Tobacco chewer ,occ.alcoholic Nonvegeterian(chicken,mutton,fish,pork) Water from tank supply. Drug history- No h/o antihelminthic drug Family history-No h/o similar complaint in any family member. No h/o major illness(TB,DM,HTN) Pet animals-Hen,Duck,Cow

General examination

Averagely built Weight-65kg Height-5ft7inch Pulse-86/min B.P-130/86mm of Hg CVS-heart sound normal,no murmur RS-NAD P/A-NAD CNS-NAD

Local examination Inspection- swelling 2x1cm in size,oval in shape, at left

lateral infraorbital margin,indistinct edges,smooth surface,mobile ,not adherent to overlying skin.

Palpation-Inspectory finding are confirmed.

swelling 2x1 cm,oval in shape,firm in consistensy,illdefined edges,mild tenderness,compressible no fluctuation,no fluid thrill,no translucency, no impulse on coughing,no pulsality,not fixed to underlying bone and overlying skin. no regional lymph node enlarged.

INVESTIGATIONS
ROUTINE BLOODWBC, TLC- 6900/cmm, DLC- N-80,L-20,E-0,M-0,B-0 ESR-5mm/hr(westergreen ) RBS-76mg% BT-2min10sec CT-5min15 sec

COMPLETE HEMOGRAM:
Hb-14% PCV-44% RBC-5.87million/cmm MVC-78.5cu,MCH-25.5cu,MCHC-32.6cu

Cond
STOOL EXAMINATION:

Few RBC&Pus cells No ova,parasite&cyst X- RAY CHEST: Normal

X-RAY LEFT ORBIT(AP&LATERAL)

Normal
USG OF LEFT EYE:

Cystic swelling in left infraorbital region,size 2x1 cm (gain-81db,dyn- 67db)

SURGICAL PROCEDURE
y The skin over the swelling was carefully incised after a subcutaneous injection of a local anaesthetic agent, the coiled worm was seen immediately beneath the skin .the worm was gently extracted and sent for morphological examination

HPE OF CYST:
Picture shows cystic structure lined by a flattened epithelium and the wall is composed of granulated tissues.
Impression: Nonspecific inflammatory cyst Low Magnification High Magnification

MORPHOLOGICAL STUDY OF PARASITE: Dirofilaria species Length:12cm Breadth:0.6cm showed active movement on removal Idetified by thick laminated cuticle,broad lateral chords and large muscle cells

y POST OPERATIVE: Inj voveron sos

Tab ciplox 500mg twice daily Tab orthobid plus twice daily Ciplox eye ointment Tab DEC 6mg/kg body wt

FOLLOW UP: - stitch were removed after 1 wk -No swelling, no ocular movement restriction.

Discussion
y Dirofilariasis , a disease commonly found in carnivorus
mammals ,is uncommon in human. y Two important species involving eye are D.tenuis and D. repens.
In India only 3 cases of subcutaneous Dirofilaria in human has been reported till today . Out of them in only one case removed.

live worm was

y First case in 1976 (Joseph),second in 2000(Sekar),and third in 2003(mallick and Ittyerah) ,all cases were reported from kerala. y Dirofilarial worm are identified by their thick laminated cuticle, broad lateral chords and large muscle cells.

Discussion cond

..

y Surgical removal of worm is tretment of choice and

generally further treatment is not recommended.