ELISA-Confirmed Bilateral Ocular Toxocariasis with Different Features

Area of Science:

• Ophthalmology
• Infectious Diseases
• Parasitology

Background:

• Ocular toxocariasis, caused by Toxocara species infection, is a rare but serious condition.
• It typically presents with unilateral ocular inflammation and vision loss, often mimicking other intraocular pathologies.

Observation:

• A 56-year-old man presented with disparate symptoms in each eye: severe pain and vision loss in the right eye (RE) with vitreous opacification, and posterior hemorrhagic granuloma with vascular sheathing in the left eye (LE).
• Laboratory tests revealed elevated IgE, positive serum Toxocara canis IgG, and detection of Toxocara antibodies in aqueous humor from both eyes.
• Intraocular fluid analysis, including vitreous fluid from the RE, confirmed the presence of Toxocara antibodies.

Findings:

• Enzyme-linked immunosorbent assay (ELISA) confirmed Toxocara canis infection in both eyes, with antibody titers detected in serum, aqueous humor, and vitreous fluid.
• The patient received a combination of topical/oral steroids, oral albendazole, and underwent phacoemulsification with therapeutic vitrectomy in the RE.
• A laser barrier was placed around the granuloma in the LE.

Implications:

• This case highlights the importance of considering ocular toxocariasis in patients with unexplained intraocular inflammation, even with atypical bilateral presentations.
• Accurate diagnosis using serological and intraocular fluid analysis is crucial for effective management.
• Successful treatment involving medical therapy and, in this case, vitrectomy, can lead to favorable visual outcomes.