Ocular dirofilariasis
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