A patient presents with one week of left eye redness and irritation. There was no inciting event or trauma. At presentation, his vision was 20/20 in both eyes, intraocular pressure within normal limits, and pupils equal and reactive bilaterally without afferent pupillary defect. Exam was notable for conjunctival injection in the left eye nasally, inferiorly, and temporally with a live, motile worm in the subconjunctival space. Surgical extraction of the worm was performed with subconjunctival lidocaine to paralyze the worm, followed by conjunctival peritomy, and dissection and extraction of the worm from the subconjunctival space and Tenon’s capsule. The worm was excised in one piece and sent for pathology. Parasitological examination identified the worm as consistent with dirofilarial species. He was discharged with neomycin-polymyxin B-dexamethasone ophthalmic drops to taper over 4 weeks and given one dose of ivermectin 15mg. The patient’s vision remained 20/20 after surgery with significant improvement in conjunctival injection and irritation at his one month post-operative appointment.
Presentation Date: 08/31/2023
Issue Date: 09/15/2023