Patient: 41-year-old woman from Beijing
Symptoms: The patient went to the hospital because he felt something was stuck in his right eye. When the doctor looked into her eyes, they realized that the outer surface of the cornea appeared to be damaged, but they couldn’t find any foreign objects. They prescribed patient eye drops to treat eye irritation and prescribed another type with antibiotics to prevent infection.
What happened next: Eye drops did not relieve the woman’s symptoms, and she returned to the hospital the following month with the same feeling as something was stabbing her in her eyes. She also reported persistent redness and itching of the eyes.
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When doctors reconsidered her eyes, they found that this time the tissue under her upper eyelid was inflamed and appeared to depict “serious” acne-like bumps, which they wrote in their report of the incident. They used a device called eyelid retractor to pull the eyelid back and examined the tissue below in more detail.
Diagnosis: There, the doctor discovered four small white insects swelling. The medical team applied a local anesthetic (a drug that paralyzes the area), then removed the worm with forceps and sent the extracted worms to the laboratory. Microscopic and genetic analyses of worms revealed that they are species called Seradiacalipida, also known as Oriental Eyeworms, which can cause parasitic infections called Seradiasis.
Treatment: After extracting worms from women’s eyelids, doctors rinse their eyes with the solution: “Make sure there are no insects left,” they wrote in the report. She was also prescribed an antibiotic-containing eye ointment for several times a day, which helped to reduce the risk of subsequent bacterial infections.
“After a week, the patient’s symptoms were significantly relieved and no recurrence was reported over the next two months,” her doctor wrote.
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What makes the case unique: Teradiasis is relatively rare in humans. It is more common in animals such as cows, dogs, cats, foxes and rabbits. Worms are transmitted to these animals via flies carrying parasites. Flies eat the animal’s tears and deposit worm larvae in their eyes as they do. The larvae then mature in the eyes – often at the eyelids, specifically, by another passing fly, and continue their life cycle. Various Theradia species can cause infection, but T. Callipadeta is the most common culprit.
Historically, most cases of human teradiasis have been reported in Asia, with China reporting the largest overall number. Over 100 years, just over 650 cases were reported between the country’s first human cases in 1917 and 2018.
“Teradiasis cases are reported primarily in agricultural areas and areas where contact with livestock is likely,” the report authors state. Furthermore, many people affected by reports of disease recall that they have been involved in animal care and/or have been particularly recently exposed to fly.
However, in this case, the source of infection in women was not 100% certain. The patient is an office worker based in the urban centre, and she did not recall recent exposure to flying insects. However, she recently reported that she had a pet cat who had an eye infection. “No pathological examination of the cat was done because the patient refused,” her doctor noted. Therefore, cats were a possible source of insects, which was not officially confirmed.
The authors of the report concluded that even in urban areas, doctors should recognize symptoms of ceradiasis and consider it a potential diagnosis. Symptoms range from mild to severe, including itching in the tissues that cover the eyes and eyelids, eye pain, bleeding or inflammation, corneal ulcers, and changes in vision. Parasitic infections can be complicated by secondary bacterial infections that exacerbate these symptoms. They added that doctors should ask if the patient has pets or if they have recently come into contact with flying insects.
This article is for informational purposes only and is not intended to provide medical advice.
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