Onchocerciasis (River Blindness) Follow-up

Updated: Oct 06, 2017
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Follow-up

Inpatient & Outpatient Medications

Patients with onchocerciasis should receive ivermectin 150 mcg/kg every 3-6 months.

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Deterrence/Prevention

Travelers to endemic area can avoid onchocerciasis by avoiding vector contact with protective clothing and repellants.

Population-based prevention strategies in some of the endemic areas of Africa and South America are based on elimination of blackfly vector and regular (every 6-12 mo) mass ivermectin treatment of affected individuals.

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Complications

Ocular complications of onchocerciasis include blindness secondary to keratitis, pannus formation, and corneal fibrosis. Posterior segment complications include chorioretinitis, intraretinal deposits, open-angle glaucoma, and optic atrophy.

Cutaneous complications of onchocerciasis include skin atrophy, depigmentation, and sowda (chronic popular dermatitis limited to one limb). A loss of skin elasticity (hanging groin) may also occur.

Hematologic and immunologic complications of onchocerciasis include chronic lymphadenopathy.

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Prognosis

Some eye manifestations and dermatitis resolve in patients undergoing ivermectin treatment every 6-12 months for the lifetime of the adult worm (approximately 12 years).

Blindness, skin atrophy, and depigmentation do not improve with treatment. The life expectancy in blind persons is decreased secondary to difficulty coping with activities of daily living, by an estimated 4 years.

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Patient Education

Travelers to areas where onchocerciasis is endemic should be counseled to use protective clothing treated with permethrin and insect repellants such as DEET.

Patients, particularly those with high microfilarial load and ocular involvement, should be cautioned on the potential complications of ivermectin therapy that may result from dying microfilaria.

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