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 in extraocular disease. [25]
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. [34, 29]
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.
Surgical Care
Destruction of the larvae in situ by photocoagulation, [30] 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. [13]
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. [13] 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. [32]
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. [33, 35] Viscoexpression allows removal of an intact cyst through a small limbal incision.
Anterior subconjunctival cysts may be treated with excision biopsy. [29] 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.
Consultations
A neurology consultation may be required in individuals with concurrent neurocysticercosis.
Prevention
Cysticercosis can be prevented through practicing good hygiene measures, such as washing hands frequently, washing raw vegetables and fruits well before consumption to prevent fecal-oral transmission, and avoiding consumption of raw or undercooked pork and other meat.
Long-Term Monitoring
Serial B-scan ocular ultrasonography, CT scanning, or MRI of the orbit helps to follow the resolution of the cyst, which is recognized by the disappearance of the scolex.
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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.
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B-scan ocular ultrasonography demonstrating cysticercus within an extraocular muscle observed as a well-defined cystic mass with a central hyperechoic area.
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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.
