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Ocular Cysticercosis Workup

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

Laboratory Studies

Positive test results from a serum enzyme-linked immunosorbent assay (ELISA) for anticysticercal antibodies help confirm the diagnosis; however, negative test results do not exclude cysticercosis.

A CBC count may reveal eosinophilia.[1]

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Imaging Studies

Imaging findings are more reliable than laboratory investigations in establishing a diagnosis.

B-scan ocular ultrasonography reveals a well-defined cystic lesion with clear contents and a hyperechoic area suggestive of a scolex.[26] This may be observed intraocularly or within the extraocular muscles. Associated retinal degeneration, if present, may also be observed. Ultrasonography is an effective and economic alternative to MRI and CT scanning to detect cysticerci in the orbit and in eyes with hazy media.[27, 28] See the image below.

B-scan ocular ultrasonography demonstrating cystic B-scan ocular ultrasonography demonstrating cysticercus within an extraocular muscle observed as a well-defined cystic mass with a central hyperechoic area.

CT scanning of the orbits is a reliable technique to help establish a diagnosis of ocular cysticercosis. Compared with MRI, CT scanning is less expensive and less time-consuming. The characteristic feature is a hypodense mass with a central hyperdensity suggestive of the scolex. Usually, a solitary cyst with wall enhancement is observed.[29] Adjacent soft-tissue inflammation may be present. The scolex may not be visible if the cyst is dead or ruptured and has surrounding inflammation. Concurrent neurocysticercosis may be present and should be excluded.[30] See the image below.

CT scanning of the orbit demonstrating cysticercus 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.

MRI reveals a hypointense cystic lesion and hyperintense scolex within the extraocular muscle. See the image below.

MRI of the orbit demonstrating deep orbital cystic 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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Procedures

Fine-needle aspiration of the cyst may be obtained to confirm the diagnosis.

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Histologic Findings

Tissue reaction is less or minimal when the cyst is alive. Scolex with hooklets may be identified within the cyst. Gradual absorption of the dead parasite results in a violent tissue reaction. The fibrous cyst wall may be surrounded by a florid inflammatory response consisting of eosinophils, polymorphs with granulomatous reaction, and giant cell formation without caseation.

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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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