Fulminant orbital myiasis in a young immunocompetent host

A young man presented in the emergency department for pain and loss of vision in the right eye. On examination, a deformed globe with a massive infestation of orbit with live maggots and necrotic slough was noted. The vision showed no light perception in the right eye, with a normal left eye examination. Several live maggots were removed from the right orbit. The maggots were identified as Chrysomya species larvae. MRI of the brain and orbit showed a markedly deformed globe with mucosal thickening of the ethmoid sinus with disrupted lamina papyracea. Despite having no identifiable immunocompromised state, the patient showed rapid progression along with superadded bacterial infection of the necrotic slough. The patient was treated by exenteration of the right orbit with the removal of necrotic tissue and larvae. This case report elaborates on the comprehensive management of a challenging scenario of fulminant orbital myiasis in a young immunocompetent patient.