When Tumor Isn’t Tumor: Periocular Myiasis by Dermatobia hominis

We present a case of periocular furuncular myiasis caused by Dermatobia hominis . The patient presented with a 20-day history of pruritic swelling of the upper right eyelid, initially misdiagnosed as recurrent hordeolum by multiple ophthalmologists. Clinical examination revealed a cutaneous opening with pulsatile serous discharge, suggestive of larval infestation. A history of recent rural travel raised suspicion for cutaneous myiasis, and ultrasonography confirmed the presence of a single larva within the eyelid. A history of recent rural travel raised suspicion for cutaneous myiasis caused by D . hominis (human botfly). Ultrasonography confirmed a single larva within the eyelid. The larva was surgically extracted under general anesthesia, resulting in immediate relief of symptoms. Additional subcutaneous nodules on the chin and forearm were treated nonsurgically using topical occlusion, allowing spontaneous larval expulsion. Oral ivermectin was administered as adjunct therapy to address potential systemic involvement. Follow-up showed full resolution without recurrence. This case highlights the diagnostic challenges posed by eyelid myiasis in endemic areas, particularly when it mimics common bacterial or inflammatory conditions, and emphasizes the need to consider parasitic infections in patients with chronic eyelid swelling in endemic regions.