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Orbital Myiasis

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Presenting Author: Dr. Kshitij M Parekh, Resident: Dr. Vasantrao Pawar Medical College, Guide: Dr. Dhiraj Balwir, Associate Professor: Dr. Vasantrao Pawar Medical College

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Orbital Myiasis

  1. 1. Presenting Author: Dr. Kshitij M Parekh Resident, Dr. Vasantrao Pawar Medical College Guide: Dr. Dhiraj Balwir Associate Professor Dr. Vasantrao Pawar Medical College
  2. 2. A Rare Case Of Orbital Myiasis
  3. 3.  A maggot is the larva of a fly (order Diptera); most commonly the larvae of Brachyceran flies, such as houseflies, cheese flies, and blowflies.  ‘Myia’ is a Greek word meaning ‘fly’. ‘Myiasis’ is a condition caused by infestation of the body by maggots. We report a case of orbital myiasis of the eyelid.  Ophthalmomyiasis progresses rapidly and can completely destroy orbital tissues within days.  It also destroys the bony tissues extending the infection to the brain.
  4. 4.  A female Hausabai Bhor, 75 years old with complaints of pain and feeling of some moving object in the left eye of 5 days duration.  One month before she had a history of dog bite on the left eye.  She did not receive any treatment prior.
  5. 5.  On ocular examination  The patient was having visual acuity 6/9 in both eyes.  She had a lacerated wound over both the eyelids of the left eye.  There was severe degree edema and derangement of the anatomical configuration of upper eyelid.  The wound was filled with pus.  The nasal bridge was also damaged  Lacrimal sac was missing.  The conjunctiva was congested.  Cornea showed mild edema.  Ocular movements were normal.  The right eye was normal
  6. 6.  CT-scan reports showed intact bony walls of the left orbit.  Hemogram showed mild leucocytosis.  Surgical debridement under local anesthesia was done.  The larvae were removed with the help of forceps after instilling turpentine oil..
  7. 7.  The pus and exudates were cleared off till the healthy tissue was reached.  On removal of the pus from the wound the black headed larvae were seen.  Turpentine oil forced the aerobic larvae to surface for air, at which time they could be captured by forceps.  Utmost care was taken to remove each of the larvae completely so as to prevent foreign body reaction.  Additionally, lidocaine was injected into the floor of the cavity  After 3 days the wound was free of larvae and started healing.
  8. 8.  Around 15-20 larvae were captured and the wound was filled with 10% povidine iodine solution.  Intravenous cefotaxime 1gm b.d. was started.  Tetanus immunization was done.  Fresh granulation tissue started appearing.  The edema subsided gradually by the 7th day.  There was complete resolution of the oedema by the 15th day.  The wound healed by secondary intention.
  9. 9.  No delay should be done in case of treating the open wound and it should be covered to prevent access to flies.  Wound should be properly managed post- operatively with antiseptic dressings and antibiotics..  There is no absolute method for protection against myiasis.  Adequate personal hygiene and proper care of wounds helps to a large extent in preventing this catastrophe.  Treatment of debilitating underlying conditions if any needs specific attention.

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