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B r i t . J . O p h t h a l . ( 1 9 5 6 ) 4 0 , 1 8 3 .CASE NOTES

COENURUS CYST OF THE EYE*BY

A . J . BOASEU g a n d a

P A R A S I T I Z A T I O N o f t h e h u m a n e y e b y t h e " g i d " worm ( g e n u s M u l t i c e p s )d o e s n o t a p p e a r t o h a v e b e e n r e c o r d e d h i t h e r t o . T h e f o l l o w i n g two c a s e sa r e t h e r e f o r e r e p o r t e d .

C a s e R e p o r t sC a s e 1 , a m a l e A n k o l e n a t i v e o f U g a n d i , a g e d 2 1 , a t t e n d e d i n J a n u a r y , 1 9 5 4 , c o m p l a i n i n gt h a t h i s l e f t e y e h a d b e e n p a i n f u l f o r o n e w e e k . T h e r e w a s c i l i a r y i n j e c t i o n , p r o f u s e f i n ep r e c i p i t a t e s , a n d a m a r k e d a q u e o u s f l a r e . T h e p u p i l w a s s m a l l , a c t i v e , a n d r e g u l a r .A t r o p i n e w a s i n s t i l l e d , b u t w h e n h i s t u r n f o r f u n d o s c o p y a r r i v e d t h e p a t i e n t h a d d i s a p -p e a r e d . He w a s n e x t s e e n i n N o v e m b e r , 1 9 5 4 , c o m p l a i n i n g o f h e a d a c h e a n d p a i n i n t h el e f t e y e , w h i c h w a s b l i n d e x c e p t f o r a s m a l l n a s a l f i e l d . M a c r o s c o p i c a l l y a y e l l o w r e f l e xw a s v i s i b l e t o w a r d s t h e n a s a l s i d e . T h e p u p i l d i l a t e d w i d e l y w i t h a t r o p i n e r e v e a l i n g af e w s l e n d e r a t t e n u a t e d p o s t e r i o r s y n e c h i a e . A l a r g e c y s t c o u l d b e s e e n i n t h e v i t r e o u sm o s t l y i n t h e n a s a l h a l f . T h r e e w h i t e p a t c h e s n e a r i t s s u r f a c e w e r e r e c o g n i z e d a s s c o l i c e sb y a d e f i n i t e t h o u g h v e r y s l u g g i s h m o t i l i t y . T h e e y e w a s r e m o v e d 2 w e e k s l a t e r a t t h ep a t i e n t ' s r e q u e s t b e c a u s e o f p a i n . F i g . 1 s h o w s t h e b i s e c t e d g l o b e h i n g e d a t t h e o p t i c d i s c

F I G . 1 . - B i s e c e d g l o b e f r o m C a s e 1 .* R e c e i v e d f o r p u b l i c a t i o n December 1 2 , 1 9 5 5 .

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1 8 4 A . J . BOASE( t h e c o r n e a h a d b e e n r e m o v e d f o r k e r a t o p l a s t y on a n o t h e r c a s e ) .

P a t h t o l o g i c a l R e p o r t . - " On s a g i t t a l s e c t i o n t h e e y e w a s f o un d t o b e c o m p l e t e l y d i s o r g a n i z e d ,m o r e t h a n h a l f t h e g l o b e b e i n g o c c u p i e d b y a c y s t w h i c h c o n s i s t e d o f t h r e e w i d e l y - c o m m u n i c a t i n gl o c u l i , o n t h e w a l l s o f w h i c h w e r e 2 6 s c o l i c e s , a l l w e l l f o r m e d w i t h t h i r t y h o o k l e t s e a c h , r a n g i n g i nl e n g t h f r o m 8 8 t o 1 4 8 - 8 m p . "C a s e 2 , a f e m a l e R u a n d a b a b y , o n e y e a r o l d , p r e s e n t e d w i t h a l a r g e c y s t b e n e a t h t h e b u l b a rc o n j u n c t i v a o f t h e r i g h t e y e o n t h e t e m p o r a l s i d e . T h e g l o b e w a s m a r k e d l y d i s p l a c e dt o w a r d s t h e n o s e . T h e m o t h e r i n s i s t e d t h a t t h e s w e l l i n g w a s o f 3 w e e k s ' d ur a t i o n o n l y .A t o p e r a t i o n , a f t e r a c o n j u n c t i v a l i n c i s i o n t h e c y s t j u s t " o o z e d " o u t o f i t s b e d ; n o d i s -s e c t i o n w a s n e c e s s a r y a n d t h e r e s e e m e d t o b e n o c o n n e c t i n g t i s s u e s t r a n d s b e t w e e n i t a n di t s b e d . I t w a s a f l a b b y o v o i d s t r u c t u r e w i t h many w h i t e n o d u l e s s h o w i n g t h r o ug h av e r y t h i n w a l l .

P a t h o l o g i c a l R e p o r t . - " A f t e r f i x a t i o n i n f o r m o l s a l i n e t h e c y s t w a s o f l o n g o v o i d s h a p e , 1 8 x 7x 7 mm. ( F i g . 2 ) . G r o u p s o f s c o l i c e s w e r e v i s i b l e t h r o u g h t h e d e l i c a t e w a l l a n d w e r e f o u n d t o b ei n g r o u p s , e a c h r o ug hl y l i n e a r . 1 6 2 s c o l i c e s w e r e c o u n t e d . E a c h s c o l e x c o n t a i n e d 2 8 h o o k l e t s( F i g . 3 ) , a l l w e l l f o r m e d a n d r a n g i n g i n l e n g t h f r o m 1 0 7 t o 1 4 9 m , u . T h i s i s a c o e n u r u s c y s t , o fw h i c h o n l y o n e s p e c i e s , C . c e r e b r a l i s ( f r o m M. m u l t i c e p s ) i s n ow r e g a r d e d a s p a r a s i t i z i n g m a n . "

*..:.:.. . : S ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ .F I G . 2 . C y s t f r o m C a s e 2 .

V.-~~~~~~~~~f'4 ~ ~ ~ ~ ~

F I G . 3 . - D r a w i n g o f h o o k l e t s i n c y s t f r o m C a s e 2 .

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COENURUS CYSTD i s c u s s i o n

T h e a d u l t M. m u l t i c e p s i s a common p a r a s i t e o f d o g s . I t s o v a , p a s s e d i nt h e f a e c e s , a r e i n g e s t e d b y s h e e p a n d d e v e l o p a s c o e n u r u s c y s t s i n t h ec e n t r a l n e r v o u s s y s t e m , g i v i n g r i s e t o t h e s y n d r o m e o f " b l i n d s t a g g e r s " .T h e l i f e c y c l e i s c o m p l e t e d w h e n d o g s e a t t h e b r a i n s o f i n f e c t e d s h e e p . I t i ss u r p r i s i n g t h a t t h e c l o s e a s s o c i a t i o n b e t w e e n man a n d d o g d o e s n o t m o r eo f t e n l e a d t o h u m a n p a r a s i t i z a t i o n , y e t r e c o r d e d i n s t a n c e s i n t h e l i t e r a t u r et o t a l o n l y s i x t e e n , n o n e a f f e c t i n g t h e e y e ( R a p e r , 1 9 5 5 ) . An i n f o r m a t i v e a c -c o u n t o f t h e c o n d i t i o n i s g i v e n b y J o h n s t o n e a n d J o n e s ( 1 9 5 0 ) w i t h t h i r t e e nr e f e r e n c e s t o t h e l i t e r a t u r e .

S u m m a r yTwo c a s e s o f c o e n u r us c y s t - o f t h e e y e a r e r e c o r d e d .

I a m i n d e b t e d t o my f r i e n d , D r . A l a n B . R a p e r , S e n i o r P a t l 4 o l o g i s t , U g a n d a , f o r t h e p a t h o l o g i c a li n v e s t i g a t i o n s a n d t h e r e p o r t s t h e r e o n , a n d f o r much i n f o r m a t i o n o n t h e s u b j e c t . T h e p h o t o -g r a p h s w e r e t a k e n b y M r . T . S a l t h o u s e o f t h e P h o t o g r a p h i c D e p a r t m e n t o f M a k e r e r e C o l l e g eM e d i c a l S c h o o l .REFERENCES

J O H N S T O N E , H . G . , a n d J O N E S , 0 . W. ( 1 9 5 0 ) . A m e r . J . t r o p . M e d . , 3 0 , 4 3 1 .R A P E R , A . B . ( 1 9 5 5 ) . P e r s o n a l c o m m u n i c a t i o n .

1 8 5

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doi: 10.1136/bjo.40.3.1831956 40: 183-185Br J Ophthalmol

A. J. Boase

EYECOENURUS CYST OF THE

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