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A 5-YEAR-OLD boy with inferior orbital swelling and an erythematous mass arising from the inferior cul-de-sac of his right eye (Figure 1 and Figure 2) was seen by an Air Force Mobile Ophthalmic Surgical Team working in a rural area of the Republic of Honduras. The respiratory pore of a late-stage larva of the human botfly (Dermatobia hominis) was located in the anterior orbit. The larva was gently removed under general anesthesia through a small incision in the conjunctiva (Figure 3, Figure 4, and Figure 5).
Five-year-old Honduran boy with right inferior orbital swelling and erythema.
Examination under anesthesia, demonstrating right eye chemosis and inferior cul-de-sac mass.
A large white larva being removed from the right anterior orbit through a conjunctival incision.
Complete late-stage human botfly larva immediately after removal.
Based on the morphology of the anterior and posterior spiracles and the exterior spines, the larva was determined to be a mature larva of the human botfly (Dermatobia hominis).
Ophthalmomyiasis refers to the invasion of the lids, conjunctiva, cornea, and rarely the orbit or globe of the mammalian eye by fly larvae (order Diptera). The sheep nasal botfly (Oestrus ovis) is the most common cause of ophthalmomyiasis.1 The human botfly (D hominis) is the most common cause of cutaneous myiasis in Central and South America, but few cases of external ophthalmomyiasis and no previous case to our knowledge of orbital invasion have been reported.2
The female botfly glues her eggs onto the abdomen of a captured mosquito or other common fly. When the carrier insect lands on a human, the larva, or bot, hatches, burrows into the skin, and positions itself "head down" to feed, breathing through caudal respiratory spiracles. A furuncle with a central pore develops as the bot matures, molting twice until reaching 18 to 24 mm. The larva withdraws through a central punctum, falling to the ground and pupating before emerging as a mature botfly.3 Chloroform or lidocaine to anesthetize the bot may facilitate surgical removal as does occluding the breathing hole with ointment, beeswax, chewing gum, or pork fat.4
Accepted for publication October 18, 1999.
Reprints: Randall L. Goodman, MD, Wilford Hall Medical Center, Ophthalmology Department, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX 78234.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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