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An otherwise healthy 54-year-old woman presented with an erythematous right lower eyelid lesion with a vermiform appearance, accompanied by pruritus and pain (Figure 1A). The lesion resolved after 1 month, but she developed redness and swelling of the inner part of her right conjunctiva the next day (Figure 1B). She denied any vision changes, eye pain, eye discharge, or systemic symptoms, such as fevers, chills, night sweats, weight loss, or diarrhea. The patient had recently immigrated from rural Moldova 1 month prior to presentation, where she had exposure to farm animals, including dogs and cats. She had not traveled to any other countries.
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B. Injection of subconjunctival lidocaine followed by surgical removal of the lesion
The patient presented with a pruritic eyelid lesion for 1 month, followed by conjunctival swelling. Careful slitlamp examination showed a slowly mobile nematode coiled under the bulbar conjunctiva. No nematode was visible in the anterior chamber, vitreous, or retina. The organism was suspected to have migrated from the eyelid, likely the site of inoculation, into the subconjunctival space. Combined with the patient’s recent travel from Moldova, these findings raised suspicion for a parasitic infection with Dirofilaria species endemic in Moldova.1 After injection of subconjunctival lidocaine, 1%, with epinephrine to paralyze the nematode, a small conjunctival incision was made, and the worm was removed intact using forceps.2 Pathological examination demonstrated an 11.8-cm-long nematode with a maximum diameter of 0.5 mm and tapered ends (Figure 2). Transverse sections showed a multilayered cuticle with external longitudinal ridges approximately 7 μm wide with 11 μm between ridges, morphological features characteristic of Dirofilaria repens.3
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Kyle Kirkland, DO, Marr Eye Center, 3030 University Dr E, College Station, TX 77845 (email@example.com).
Published Online: August 4, 2022. doi:10.1001/jamaophthalmol.2022.2147
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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