Optical coherence tomography of a subretinal granuloma in simultaneous visceral and ocular larva migrans

Ocular toxocariasis is usually a unilateral posterior uveitis in otherwise asymptomatic children. The authors report the rare occurrence of presumed ocular toxocariasis presenting as a juxtapapillary lesion in a 52-year-old woman with systemic manifestations of visceral larva migrans.

A 52-year-old woman presented with blurred vision in her right eye for 2 months. She shared her bedroom with two puppies. Best-corrected visual acuity was 20/20 in both eyes; slit-lamp examination was unremarkable. Funduscopy revealed a whitish, elevated, juxtapapillary retinochoroidal lesion of approximately one disk diameter size with macular star formation. She also developed severe respiratory distress and diarrhea. An intense eosinophilia was detected. Investigation included a liver biopsy positive for Toxocara antigens upon staining with chromogen 3,3'-diaminobenzidin and anti-Toxocara immunoglobulin G >10,240 (enzyme-linked immunosorbent assay). Treatment with albendazole and corticosteroids was implemented. Third generation optical coherence tomography (Stratus Tomographer, Model 3,000, Carl Zeiss Ophthalmic Systems, Inc., Dublin, CA) (OCT) of the macular area was unremarkable, except for a slight increase in retinal thickness as it approached the inflammatory lesion. Two months after treatment, there was a hypopigmented scar with localized condensed vitreous opacities. The OCT demonstrated traction along the vitreoretinal interface as the inflammation waned. A conservative approach was maintained as visual acuity remained stable.

OCT imaging may offer a practical means of locating and staging posterior pole lesions due to ocular toxocariasis.