Index pediatric case of ocular thelaziasis from Middle East: Tenacious clinical acumen in overcoming diagnostic dilemma

A 9-year-old girl presented with a history of extrusion of threads from the right eye for 1 month. Ocular examination was normal with papillae in the right eye and 6/6 vision. Initial laboratory analysis of thread-like specimen was reported as hair. Despite delay in confirmatory diagnosis, strong clinical intuition based on thorough literature review, specimen appearance, and intermittent serial slit lamp examinations led to removal of a motile worm from her eye. Diagnosis as Thelaziasis was later confirmed. Removal of the worm is the mainstay of treatment in humans. She was prescribed Tablet Albendazole, advised preventive measures, closely followed up for 8 months and had no recurrences. Although rare in humans, this index pediatric case of Thelaziasis from the Middle East highlights the diagnostic challenges in non-endemic areas where it may be misdiagnosed due to unfamiliarity. It reiterates importance of awareness, public health measures and the need to consider parasitic causes in persistent unusual ocular symptoms.