Ophthalmomyiasis is the infestation of the eye by the larval form (maggots) of flies of the order Diptera. Involvement may include eyelids and conjunctiva (ophthalmomyiasis externa), or the larva may invade inside the eye (ophthalmomyiasis interna).1 Ophthalmomyiasis interna may be further subdivided into anterior and posterior based on the larva being in the anterior or posterior segment of the eye, respectively.2 However, posterior migration of an anterior larva has been previously reported3 and also occurred in our patient. Unpredictable behavior of the larva inside the eye results in difficulty in making treatment decisions.
A 12-year-old boy had redness and mild pain in his left eye for the past 8 days. At initial examination, visual acuity was 20/20 OD and 20/25 OS. Examination results of the right eye were unremarkable, whereas the left eye showed mild ciliary injection, deep anterior chamber with 2+ cells, and a white 6-mm larva attached to the iris at the 11-o’clock position (Figure 1). No entry site was found. Direct ophthalmoscopy through the undilated pupil showed a normal retina. Three hours later while the patient was being prepared for surgery, the larva left the anterior chamber. Careful examination showed a full-thickness hole (iridotomy) in the peripheral iris produced by the larva, through which it had migrated posteriorly between the iris and zonulae. The patient was closely followed up for emergency removal of the larva in case of remigration of the larva into the anterior chamber. Two days later, the larva moved into the vitreous cavity and floated freely (Figure 2). After 3 days, it was very close to the retina and produced retinal hemorrhages. Pars plana deep vitrectomy was performed and the larva was removed completely and sent in normal saline for parasitologic studies. Three days later, the patient developed retinal detachment and underwent another surgery to reattach the retina. Parasitologic studies showed a stage 1 larva belonging to blowflies (Diptera: Calliphoridae). After 6 months, the retina was attached and best-corrected visual acuity was 20/200 due to posterior subcapsular cataract.
A white larva attached to the iris.
The larva floats in the vitreous cavity.
Ophthalmomyiasis interna is a rare disease caused by larvae of Diptera flies.2 These larvae penetrate the sclera and migrate into the eye.1 However, the entry site is usually not apparent.2 In most cases the larvae are found in the posterior segment appearing as posterior uveitis, retinal detachment, and subretinal migratory tracks.1,2 Anterior ophthalmomyiasis interna is less common and appears clinically as anterior uveitis.2 Usually there is only 1 larva inside the eye; however, 2 larvae in the same eye3 and bilateral involvement4 have also been reported.
Prognosis of vision in these patients varies greatly. The causes of decreased vision in patients with ophthalmomyiasis interna include uveitis, subretinal migratory track crossing the macula, retinal detachment, retinal and vitreous hemorrhage, invasion to the optic nerve, and resulting optic atrophy.1,2 Early removal of larvae decreases the potential of vision loss.1 However, the decision to remove the larva must be made on an individual basis. For a mobile subretinal larva, argon laser photocoagulation has been recommended, obviating the need for deep vitrectomy.1 For an immobile subretinal larva with scar tissue, no treatment is needed.3 In the case of retinal damage, the subretinal larva is best removed by pars plana vitrectomy and retinotomy.1,5 Because of the unpredictable behavior of larva inside the eye and potential complications of vitreoretinal surgery, we recommend dealing with the anterior chamber larva emergently and removing it through a limbal incision as soon as possible to prevent posterior migration. Additionally, it is recommended not to use pilocarpine to constrict the pupil as it may cause moving and posterior migration of the larva.3
Correspondence: Dr Sharifipour, Department of Ophthalmology, Ahvaz Jundishapour University of Medical Sciences, Imam Khomeini Hospital, Azadegan Street, Ahvaz, Iran (email@example.com).
Financial Disclosure: None reported.
Additional Contributions: Bijan Abazar, MD, Babak Vazirian, PhD, and Mahmood Rahdar, PhD, provided help in the parasitologic studies.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Ophthalmology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.