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JAMA Ophthalmology Clinical Challenge
July 2013

Anterior Chamber Angiostrongyliasis

Author Affiliations
  • 1Miami Veterans Administration Medical Center, Miami, Florida
  • 2Bascom Palmer Eye Institute, University of Miami, Miami, Florida
JAMA Ophthalmol. 2013;131(7):951-952. doi:10.1001/jamaophthalmol.2013.4620

A 52-year-old man presented with a 1-day history of redness and photophobia in the right eye. He denied changes in visual acuity, discharge, pain, or systemic concerns (eg, headache, fever, nausea/vomiting, or nuchal rigidity). He denied traveling out of the country and contact with animals or animal feces, although he did note he ate sushi. Head and neck examination revealed no lymphadenopathy or nuchal rigidity. His best-corrected visual acuity was 20/25 in the right eye and 20/30 in the left eye. Slitlamp biomicroscopy of the right eye showed 1+ conjunctival injection. The cornea was intact, with no evidence of edema. In the anterior chamber, the angle was deep and there were rare cells. A nonmobile, clear, roundworm with regular fimbriae spanning from 3 o’clock to 5:30 was visualized (Figure). A dilated fundus examination was unremarkable. Specular microscopy showed a decreased corneal endothelial cell density, as well as cellular polymegathism and pleomorphism. B-scan ultrasonography revealed a worm limited to the anterior chamber with no evidence of extension into the posterior chamber or subconjunctival space. Systemic investigation results for infection were negative.

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