The patient was an 82-year-old man with longstanding decreased vision in both eyes. The past medical history was remarkable for diabetes diagnosed 12 years previously, controlled hypertension, and chronic obstructive pulmonary disease. The visual acuity was 20/40 OD and 20/70 OS. He was pseudophakic with clear posterior capsules. The vitreous was quiet in each eye. He had remarkable fundus findings in each eye. What was/were the most likely diagnosis(es)?
The left eye had a hemiretinal vein occlusion with macular edema for which our patient had been receiving anti-VEGF treatments. There were sclerotic superotemporal blood vessels, particularly in the periphery, which was due to ischemia.
The right eye had a macular branch vein occlusion, and sclerosis of blood vessels superotemporal to the disc is a subtle finding on the wide-field photo. Attention is drawn to the nasal fibrotic mass with surrounding atrophy and hyperpigmentation. The fibrotic mass appears to be connected to the disc with straight whitish tissue. A presumptive diagnosis of toxocariasis was made. The infection starts by ingesting the eggs of Toxocara canis, which is a worm in the ascarid family. The eggs of Toxocara canis are deposited in the soil via dog feces, where they are ingested, usually by children. The eggs are hatched in the gastrointestinal tract, and the second-stage larvae travel in the bloodstream to the eye. Clinical manifestations vary widely, but a common presentation is that of our patient, in which the worm migrated from the disc or peripapillary tissues to the retina. The fibrosis emanating from the disc reflects reaction to waste material from the worm, and the round fibrotic scar is the remnant of an eosinophilic granuloma that formed as the larva died. The inflammation associated with toxocariasis can cause severe visual damage. Toxocariasis is rarely if ever bilateral.
The left eye had a hemiretinal vein occlusion with macular edema for which our patient had been receiving anti-VEGF treatments. There were sclerotic superotemporal blood vessels, particularly in the periphery, which was due to ischemia.
The right eye had a macular branch vein occlusion, and sclerosis of blood vessels superotemporal to the disc is a subtle finding on the wide-field photo. Attention is drawn to the nasal fibrotic mass with surrounding atrophy and hyperpigmentation. The fibrotic mass appears to be connected to the disc with straight whitish tissue. A presumptive diagnosis of toxocariasis was made. The infection starts by ingesting the eggs of Toxocara canis, which is a worm in the ascarid family. The eggs of Toxocara canis are deposited in the soil via dog feces, where they are ingested, usually by children. The eggs are hatched in the gastrointestinal tract, and the second-stage larvae travel in the bloodstream to the eye. Clinical manifestations vary widely, but a common presentation is that of our patient, in which the worm migrated from the disc or peripapillary tissues to the retina. The fibrosis emanating from the disc reflects reaction to waste material from the worm, and the round fibrotic scar is the remnant of an eosinophilic granuloma that formed as the larva died. The inflammation associated with toxocariasis can cause severe visual damage. Toxocariasis is rarely if ever bilateral.
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