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Ocular Cysticercosis Treatment & Management

  • Author: Smita Menon-Mehta, MBBS, DO, FRCS(Glasg); Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Nov 30, 2015
 

Medical Care

Surgical removal is mandatory in individuals with intraocular cysts. Medical therapy, other than the use of corticosteroids, is not part of treatment. In individuals with uveitis, perioperative corticosteroid administration is recommended.

Surgical excision of orbital cysts was considered the ideal treatment modality. However, deep orbital dissection and difficulty in completely excising the cyst because of the surrounding inflammatory response increase the chances of postoperative complications (eg, decreased vision, diplopia). The treatment of extraocular muscle cysticercosis has undergone a radical change with the successful results of medical alternatives to surgical excision of the cysts. Anthelminthics (eg, albendazole, praziquantel) and oral corticosteroids have been found to be effective.[23]

Cysts deep within the orbit are best treated conservatively with a 4-week regimen of oral albendazole (15 mg/kg/d) in conjunction with oral steroids (1.5 mg/kg/d) in a tapering dose over a 1-month period. Treatment may increase inflammation as the cyst involutes, leading to worsening clinical states. Thus, concomitant administration of corticosteroids is recommended to avert an inflammatory response.[31, 26]

Resolution of the cyst may take from a few days to months depending on the density of the surrounding inflammation. Based on the individual’s response to medical therapy, another course of medication may be required.

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Surgical Care

Destruction of the larvae in situ by photocoagulation,[27] cryotherapy, and diathermy has been attempted with some success. However, as intraocular cysticercosis may lead to severe inflammation following larval death, early surgical removal of the cyst is the treatment of choice.[12]

In the treatment of intraocular cysticercosis, the most common surgical approach is removal through the pars plana route following vitrectomy. Subretinal cysts anterior to the equator may be removed transsclerally, whereas subretinal cysts posterior to the equator and intravitreal cysts are best removed transvitreally.[12] Ideally, the cyst should be removed in toto. Complete surgical removal of the intact cyst results in good functional recovery in eyes with intraocular cysticercosis.[29]

The treatment of anterior chamber cysticercosis is essentially surgical. The different modalities used to remove the cyst include paracentesis, extraction with capsule forceps, cryo-extraction, erysiphake extraction, and viscoexpression.[30, 32] Viscoexpression allows removal of an intact cyst through a small limbal incision.

Anterior subconjunctival cysts may be treated with excision biopsy.[26] As the cyst is usually adherent to the adjacent muscle, excision may be difficult. Care must be taken to keep the extraocular muscle intact during dissection.

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Consultations

A neurology consultation may be required in individuals with concurrent neurocysticercosis.

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Contributor Information and Disclosures
Author

Smita Menon-Mehta, MBBS, DO, FRCS(Glasg) Consulting Staff, Department of Ophthalmology, Bahrain Specialist Hospital

Smita Menon-Mehta, MBBS, DO, FRCS(Glasg) is a member of the following medical societies: All India Ophthalmological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

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CT scanning of the orbit demonstrating cysticercus within the medial rectus muscle observed as a hypodense area with a central hyperdensity suggestive of the scolex.
B-scan ocular ultrasonography demonstrating cysticercus within an extraocular muscle observed as a well-defined cystic mass with a central hyperechoic area.
MRI of the orbit demonstrating deep orbital cysticercus within superior muscle complex observed as a hypointense area with central hyperintensity compressing the optic nerve posteriorly.
 
 
 
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