Ophthalmologic Manifestations of Onchocerciasis Treatment & Management

Updated: Oct 16, 2014
  • Author: Debora E Garcia-Zalisnak, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

Medical Care

Traditionally, DEC was used to kill microfilariae. It is not in wide use now because of the severe reactions mentioned above in the Mazzotti test.

The standard treatment now includes ivermectin given as a single dose and repeated every 6-12 months for 10 years. Ivermectin works by paralyzing the microfilariae over 6 months. It has no effect on adult worms. [8, 9]

Ivermectin has been shown to delay the development of optic atrophy, reduce the visual field loss, and decrease the severity of keratitis. More advanced chorioretinal and keratitis lesions and angle-closure glaucoma are not treated with ivermectin. Iridocyclitis can result from ivermectin therapy and can be treated with steroids and cycloplegic drops. In addition, some ivermectin-resistant strains of O volvulus have recently appeared. [10]

Doxycycline has been used against Wolbachia and has been shown to decrease microfilarial loads. [11] Animal models treated with doxycycline have had a decrease in posttreatment corneal thickness and stromal haze. [11]

Other drugs currently under investigation include rifampin, azithromycin, and moxidectin, an antifilarial drug similar to ivermectin but with a possible more sustained reduction in microfilarial levels according to early animal studies. [12]

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Surgical Care

Surgical treatments are usually directed against preventing the loss of vision caused by Ovolvulus. These include the following:

  • Cataract extraction for visually significant cataracts
  • Trabeculectomy or drainage implants for glaucoma management
  • Penetrating keratoplasty for corneal pathology
  • Vitrectomies or laser photocoagulation for chorioretinal lesions
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Consultations

Infectious disease physicians and ophthalmologists should be involved in the care of all patients with onchocerciasis.

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Diet

There are no dietary restrictions for affected patients.

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Activity

Depending on the severity of disease, patients with severe vision loss may need assistance with activities of daily living. Otherwise, patients should have as much activity as tolerated.

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