Orbital cysticercosis: clinical manifestations, diagnosis, management, and outcome.

PURPOSE: To describe the clinical manifestations, diagnosis, management, and outcome of orbital cysticercosis in a tertiary eye care center in Southern India.

DESIGN: Retrospective observational case series.

PARTICIPANTS: A total of 171 patients with orbital cysticercosis.

METHODS: Retrospective case series involving consecutive patients with orbital cysticercosis from March 1990 to December 2001.

MAIN OUTCOME MEASURES: Clinical resolution and significant residual deficit.

RESULTS: The median age at presentation was 13 years (range 2-65 years), and 93 patients (54.4%) were male. The 3 main symptoms at presentation were periocular swelling (38%), proptosis (24%), and ptosis (14%) with a median duration of 2 (range 0-24) months. The 3 main signs at presentation included ocular motility restriction (64.3%), proptosis (44.4%), and diplopia (36.8%). The cyst locations in the decreasing order of frequency were anterior orbit (69%), subconjunctival space (24.6%), posterior orbit (5.8%), and the eyelid (0.6%). In all, 80.7% of patients had cysts in relation to an extraocular muscle. The superior rectus (33.3%) was the most commonly involved extraocular muscle. Contact B-scan ultrasonography was diagnostic of cysticercosis in 84.4% of patients. Orbital cysticercosis was managed medically in 158 of 166 patients. Although 149 patients received a combination of oral albendazole and prednisolone, 1 patient received oral albendazole alone, 7 patients received oral prednisolone alone, and 1 patient received oral praziquantel. Surgery was performed in 8 patients. Clinical resolution was seen in 128 of 138 patients (92.8%) at 1 month and 81 of 85 patients (95.3%) at 3 months. A significant residual deficit was present in 29 of 138 patients (21.0%) at the final follow-up and included proptosis in 7 patients, ptosis in 6 patients, ocular motility restriction in 3 patients, diplopia in 2 patients, strabismus in 2 patients, and a combination of the above in 9 patients.

CONCLUSIONS: Orbital cysticercosis is a common clinical condition in the developing world. It typically affects young individuals and has a wide spectrum of clinical manifestations. Both B-scan ultrasonography and computed tomography scan are useful in confirming the diagnosis. Despite resolution of cysticercosis with medical management, a significant proportion of patients may have residual functional deficits.