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clinicians have long believed that the only ocular accident that occurs in this pathology is the migration of an adult worm across the conjunctiva .
recent observations describe a rare entity , the intraocular migration of an adult worm . in this case ,
an 8-month - old baby received treatment in the emergency rooms of the yaound gaeneco obstetric and paediatric hospital ( ygoph ) , yaound , cameroon .
a male baby aged 8 months and weighing 8 kg presented to the clinic in february 2008 .
he was born in ebengon , a small village in south cameroon at the border with equatorial guinea .
he is the second child of a 21-year - old farmer mother and a 30-year - old salesman father .
the child was brought to the consultation with a 3-month history of irritability , insomnia , painful red eye , photophobia , and tearing .
the right eye examination revealed blepharospasm , significant lid edema , hyperhemic conjunctiva , and a mobile living whitish organic foreign body in the anterior chamber ( figure 1 ) .
results of a general examination by a pediatrician were reported to be normal with no onchocercoma .
a multiple blood smear with hematoxylin giemsa stain , before and after hemolysis , using saponine 2% found no microfilaria on multiple mid - day samples ; a full blood count revealed moderate hypereosinophilia , and a skin snip test for onchocerciasis was negative .
the baby was hospitalized , and the midnight blood sample was also tested for lymphatic filariosis wuchereria bancrofti and brugia malayi , which have nocturnal periodicity ; this exam was negative .
after obtaining parental consent , the eye was examined under general anesthesia using an operating biomicroscope .
this examination revealed in the right eye , a moderate edema of the cornea , a white mobile worm in the anterior chamber , a hypo - pyon , a miosis with posterior synechiae of 360 , a cataract , and high intraocular pressure ( of 30 mm hg as measured with tonopen ) .
the surgical intervention consisted of a limbal - based incision between 11 and 13 oclock , expulsion of the worm anterior chamber , washout followed by a capsulotomy releasing of synechia in 360 , and a lens washout ( figures 2 , 3 ) . because sectorial iris atrophy was noted , posterior capsulorhexis was not performed and no intraocular implant inserted . instead , a peripheral iridectomy was performed at 12 oclock and the wound was sutured with 10/0 black silk .
post - operative treatment included bethamethason 20 drops twice daily , a topical combination of dexamethason and neomycine four times per day , and atropine 0.5% drops twice daily .
the doses of topical steroid treatment were tapered down progressively over 60 days . despite negative parasitemia
the follow - up was good although the cornea remained slightly troubled at the end of the treatment .
laboratory analysis of the worm revealed it to be 20 mm long and 0.5 mm diameter .
microscopy showed that the body of the worm was covered with a thick cuticle which was unstriated , the anterior extremity had a simple mouth , and the posterior extremity was rounded and showed small sessile caudal papilla and spicule .
these findings with the absence of microfilariae in the peripheral blood films , suggested the identity of the worm to be an adult male loa loa .
the presence of an intraocular adult loa loa worm in the anterior chamber was documented for the first time in cameroon in 1972 by lucot and chovet ( 1972 ) in a 14-month - old child in yaound .
no laboratory test was done to confirm the nature of the worm , but the authors made a presumptive diagnosis of loiasis . in our case ,
the child presented with 3 months of symptoms , so that we presume that the clinical signs began when the child was 5 months of age .
vedy and colleagues ( 1988 ) report that the maturation of microfilaria taken from a hematophage meal is completed within 10 to 12 days in the body of the chrysops vector . after
a human becomes infected from a fly bite , the final maturation process is completed within 3 months . based on this timeline , we can assume that the baby in our case was infected with loa loa at 2 months of age .
two hypotheses have been proposed by vedy and colleagues ( 1988 ) : the adult worm may penetrate through the sclera or the metacyclic larvae may mature in the ocular region .
our case was a baby , similar to the first case described in cameroon by lucot and chovet ( 1972 ) in which the baby was 14 months old .
our patient was younger than other children discussed in many case reports we found in our review of the literature .
our patient had similar symptoms to the cases reported by osuntokun and olurin ( 1975 ) , barua and colleagues ( 2005 ) , satyavani and rao ( 1993 ) , and carme and colleagues ( 1984 ) , with no detectable levels of microfilaremia and no history of visualization of subconjunctival or subcutaneaous migration of microfilaria .
this result suggests that the maturation in vivo of male microfilarium that did not undergo reproduction .
uveitis with hypopion and secondary cataract with corneal oedema were the anatomic complications of our case , which was diagnosed after three symptomatic months .
the two cases reported by osuntokun and olurin ( 1975 ) reported complications of painful blind eye and chronic anterior uveitis and were diagnosed after 5 and 6 months , respectively .
the case reported by satyavani and chinnaya rao ( 1993 ) was diagnosed after 15 days and resulted in no anatomic sequelae . despite negative parasitemia
, we decided to treat with dec like many other clinicians , which was justified by the hyperendemicity of loiasis in the region .
loiasis is very common in the rain forest of central and west africa ( collee et al 1996 ) .
the high frequency of loiasis in this area led vedy and colleagues ( 1988 ) to attest that there is no consultation day without removal of subconjonctival migration of adult loa loa worm .
this second case of intraocular adult loa loa worm documented in cameroon , a hyperendemic area , may raise public health concerns about the ocular complications of loiasis . according to vedy and colleagues ( 1988 ) , loa loa infection ,
whose disease burden is not exactly known , should be considered a serious parasitic infection that may lead to blindness .
these general complications are seen in patients with chronic high parasitemia , which has been shown to result from immunological reactions ( vedy et al 1988 ) .
we report a case of loa loa filariasis in an 8-month - old child who presented with a 3-month history of irritated acute red eye and insomnia . 
 examination revealed a living and active adult loa loa worm in the anterior chamber of the left eye . 
 the worm was extracted under general anesthetic .