Nonsurgical management of photoaversive ocular and systemic loiasis in Michigan

Objective: Ocular loasis refers to ocular conditions such as pain and redness caused by the movement of the Loa loa nematode through the subconjuctival space of the eye. It is a tropical disease that is very rarely seen in North America. We report the case of a 32-year-old male who was recently diagnosed with ocular loasis in the Midwestern region of the United States. Methods: He presented to the emergency department with left eye pain after seeing a "worm in his eye" the previous night. He had emigrated from Cameroon 7 years prior. Anterior segment examination revealed a translucent, motile worm in the subconjunctival space of his left eye. Results: Prior to the patient's scheduled follow-up for surgical removal of the worm, it migrated into the lower eyelid subdermal space. Serum testing confirmed the presence of Loa loa microfilariae at a concentration of >17,000 mf/mL. Conclusion: The patient was treated at the National Institute of Health (NIH) with pheresis followed by diethylcarbamazine and reported symptomatic improvement 1 month after treatment. This case report demonstrates the importance of being able to recognize and properly manage vector-borne parasites in nonendemic areas due to increased travel and climate change.

Keywords: Loa loa nematode; apheresis; ocular loiasis.