Loa Loa In Montgomery County J. Alberto Martinez, MD April 22, 2012
• Demographics: Patient FM ▫ Gender: male November 5th 2010 ▫ Race: African ▫ Country: Cameroon ▫ Age: 30• History of present illness: Two days history of FBS and itching Referred as an emergency by Dr.Suzanne Carducci O.D. for evaluation of a possible worm OS.
History• 3o Y.O African male with two days history of itching and FBS OS.• Patient looked at the mirror and saw something moving. Went to work regardles, and coworker saw something moving in his eye, urged him to see eye doctor.• Patient works at Lake Forest Mall, went to see Dr. Carducci
Past Ocular History• Two years previously, in Cameroon had two episodes of FBS, itching and red eye. Was told by his parents it was filaria and prescribed the usual treatment: Cut an onion in half and place it in front of the eye for 10 minutes. Both times the symptoms went away and the eye got “white” and stopped itching.
Social History▫ Drinks socially▫ Denies smoking▫ Student and sales associates at JCPenney’s▫ No family history noted▫ No systemic meds▫ No known allergies▫ Arrived in United States two years previously
• Orientation, Mood and Affect: ▫ Alert and oriented• Vision: ▫ Corrected VA OD: 20/25 +0.50 +0.25 X103 Exam: ▫ Corrected VA OS: 20/20 +0.75 SPHER• Slit-Lamp Exam: ▫ +2 injection of conjunctiva OS. A worm-like creature actively moving in the subconjunctival space inferotemporally.
• Prescription: ▫ Zylet 0.5% • Instructions:Plan: ▫ 1 drop TID left eye • Patient referred to LOASIS unit at NIH/NIAID
History of Present Illness• Two day history of itching, FBS, eye pain OS.• Symptoms worsened when she went to the sun• Looked in the mirror, never saw anything moving• Began experiencing headaches, saw internist who referred to Ophthalmologist• Ophthalmologist referred patient to us.
Past Medical History• Itching and swelling of wrists and hands• Initially thought to be caused by lifting plates in her job as waitress• However, symptoms persisted after leaving job.
Social History• Social History: ▫ Drinks socially ▫ Denies smoking ▫ Family History: diabetes both grandparents ▫ No systemic meds ▫ No known allergies ▫ Arrived in the US at age 14, has never been back to her country since
Exam:• Orientation, Mood and Affect: ▫ Alert, oriented, aprehensive• Vision uncorrected ▫ OD: 20/20 ▫ OS: 20/20• Slit-Lamp Exam: ▫ +2 injection. Relatively large worm actively moving in the subconjunctival space. Reassured and Transferred to microscope for removal.
• Prescription: Plan: ▫ Zylet 0.3-0.5% tid. ▫ Referred for further care to Thomas Nutman, M.D. NIH/NIAID• Patient returned for follow up on 10/5/2011. Patient stated to have FBS. Besides that no other eye symptoms.• Currently her writ and hand swelling and itching have disappeared.