A 66-year-old male with complaints of redness and swelling over white of the left eye for 6 weeks was under topical steroids in view of scleritis without relief. Visual acuity was 20/20. Anterior segment (AS) examination showed deep congestion with an 8 × 8 mm scleral nodule located 10 mm temporal to the limbus in the left eye Fig. 1. The temporal part of the nodule appeared whitish and lobulated. The anterior chamber was quiet, along with a normal appearing fundus. Blood and urine analysis were normal.Figure 1: 8x8 mm scleral noduleExcision of the nodule with 3 mm clear conjunctiva revealed a 12 cm long live worm Fig. 2, microbiologically confirmed as Dirofilaria species Fig. 3. Patient responded well to topical steroids postoperatively with no recurrence on follow-up.Figure 2: 12 cm long live worm presenting intraoperativelyFigure 3: Gross specimen on slide and microscopy under 10xDiscussion A case of a 60-year-old female from Kerala in 1976 presented with chronic swelling and ocular symptoms. Surgical excision of the nodule revealed D. repens.1 One patient from Panvel with a scleral nodule diagnosed as infective scleritis revealed two live worms on deroofing, confirmed as Dirofilaria species.2 Similarly, Patel et al. and Bhat et al. reported cases of patients with nodular swelling, diagnosed as dirofilariasis, and were managed surgically.3,4 In the above reports, prompt diagnosis on presentation and simple excision of the lesion with removal of live worms sufficed as management. Autoimmune conditions (sarcoidosis, rheumatoid arthritis), benign or malignant tumors, and other infective causes need to be ruled out. Imaging modalities like Anterior segment optical coherence tomography, (AS-OCT) and Ultrasound Biomicroscopy (UBM) aid in the easier diagnosis of such conditions. Our patient had a 3-month history of nodular swelling, initially treated elsewhere as nodular scleritis with topical steroids. The onset of a scleral nodule indicates either chronic inflammation or an exogenous infectious organism, warranting surgical excision. Lack of timely management may have implications for long-term use of topical steroids, like glaucoma or cataract. Early detection of a worm in the scleral nodule is crucial, as surgical removal is both diagnostic and therapeutic. Authors contributions Dr. Subrahmanya K. Bhat, MS Ophthalmology, Professor, Department of Ophthalmology, K.S Hegde Medical Academy, is the operating surgeon who diagnosed and treated the patient aforementioned in our report. Dr. Gokul Suresh, MS Ophthalmology, is his apprentice involved in data acquisition along with the preparation, review, and editing of the manuscript. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Suresh et al. (Thu,) studied this question.