OPHTHALMOMYIASIS INTERNA WITH INVASION OF THE OPTIC NERVE.

PURPOSE: To report a case of ophthalmomyiasis interna with optic nerve invasion that was treated with oral ivermectin and prednisone.

METHODS

Case report with retrospective review of medical records and multimodal imaging studies.

RESULTS

A Christmas tree farmer in his sixties presented with expanding multicolored, spiraling photopsias in the left eye. The visual acuity measured 20/50, and examination and imaging findings showed subretinal tracks consistent with ophthalmomyiasis interna. After several weeks of spontaneous improvement, the visual acuity decreased to 20/150 and fundus examination showed new optic disc edema that was treated with ivermectin and prednisone. Despite the development of optic disc pallor, the visual acuity improved to 20/25.

CONCLUSION

Subretinal fly larvae can occasionally exit the eye by invading the optic nerve. Treatment of optic nerve involvement with ivermectin and prednisone can result in an excellent visual outcome.