Asia Pac Allergy.  2014 Jul;4(3):134-141. 10.5415/apallergy.2014.4.3.134.

Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention

Affiliations
  • 1Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Korea. sejoon1@snu.ac.kr
  • 2Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam 463-040, Korea.

Abstract

Despite being one of the most common zoonotic infections worldwide, human toxocariasis has been one of the neglected tropical diseases. Although most human infections are asymptomatic, two main syndromes of human toxocariasis are classically recognized: systemic toxocariasis, which encompasses diseases in major organs; and ocular toxocariasis (OT), disease in the eye or optic nerve, caused by the migration of Toxocara larvae into the eye. OT is usually a unilateral disease, which typically presents as retinal granuloma, a yellowish or whitish inflammatory mass, in the posterior pole or peripheral retina. Granuloma itself or other comorbid conditions such as epiretinal membrane, macular edema, and retinal detachment can lead to permanent retinal damage and visual loss in eyes with OT. OT is diagnosed clinically by identification of clinical signs on ophthalmologic examination. Serological tests, such as enzyme-linked immunosorbent assay (ELISA) for detection of serum antibody against the Toxocara larvae, can confirm the diagnosis. In addition, serum immunoglobulin E and detection of ocular fluid antitoxocara antibody by ELISA may give additional aid to the diagnosis. Standard treatment of OT is corticosteroid in patients with active intraocular inflammation. Although the role of anthelmintic therapy is unclear, favorable outcome has been reported by combined corticosteroid and albendazole therapy in eyes with active inflammation. Prevention, by increasing public awareness and reducing the risk of infection, is also important. Recently, the association between ingestion of uncooked meat or liver and toxocariasis was reported, especially in adult patients. Future research on the potential source of infection, diagnosis, and treatment should be performed.

Keyword

Diagnosis; Toxocariasis; Treatment; Ocular toxocariasis

MeSH Terms

Adult
Albendazole
Diagnosis*
Eating
Enzyme-Linked Immunosorbent Assay
Epiretinal Membrane
Granuloma
Humans
Immunoglobulin E
Immunoglobulins
Inflammation
Larva
Liver
Macular Edema
Meat
Optic Nerve
Retina
Retinal Detachment
Retinaldehyde
Serologic Tests
Toxocara
Toxocariasis*
Zoonoses
Albendazole
Immunoglobulin E
Immunoglobulins
Retinaldehyde

Figure

  • Fig. 1 A simplified figure showing the life cycle of Toxocara canis and its transmission route and migration in human.

  • Fig. 2 Fundus photographs of retinal granuloma in a 67- (A) and 31-year-old male (B) patients with ocular toxocariasis. (A) Posterior pole granuloma appears as an oval, white lesion in the posterior pole of the retina. (B) Peripheral granuloma presents with an amorphous whitish mass with tractional membrane and retinal detachment.

  • Fig. 3 Two migration patterns of Toxocara granuloma: continuous (A) and discontinuous (B). (A) Granuloma moves into the temporal side one month after the initial visit (A, left). The dotted line in panel A denotes a reference line connecting two reference points. (B) Compared to baseline, two novel granulomas appear in the macula and inferotemporal retina.


Cited by  2 articles

A Case of Spontaneous Closure of Macular Hole in Infectious Posterior Uveitis Involving the Fovea
Min Woo Kim, Dong Yoon Kim, Yoon Jeon Kim, Soo Geun Joe, Joo Yong Lee, June Gone Kim
J Korean Ophthalmol Soc. 2016;57(1):155-160.    doi: 10.3341/jkos.2016.57.1.155.

Atypical Fundus Manifestation of Ocular Toxocariasis
Joseph Kim, Hee Seung Chin
Korean J Ophthalmol. 2019;33(5):475-477.    doi: 10.3341/kjo.2018.0121.


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