A 56-year-old man presented with severe ocular
pain and acute visual loss in the right eye (RE). His best-corrected visual acuity was hand motion in the RE and 20/30 in the left eye (LE).
Slit-lamp examination showed a severe anterior chamber reaction in the RE and a moderate anterior chamber reaction in the LE. The fundus of the LE showed a posterior hemorrhagic
granuloma with vascular sheathing whereas the fundus of the RE was not visible because of severe vitreous opacification. Blood laboratory testing disclosed hyperproduction of
IgE but no
eosinophilia. Serum
enzyme-linked
immunosorbent assay testing was positive for Toxocara canis
IgG (1:38). Toxocara antibody was also detected in the aqueous humor from both eyes (RE, 1:321; LE, 1:254). The patient was treated with topical and oral
steroids along with oral
albendazole. Additionally,
phacoemulsification, a therapeutic
vitrectomy, and vitreous cultures were performed in the RE. During the
vitrectomy, the fundus of the RE showed diffuse
retinal vascular obstruction with sheathing. Toxocara
antibodies were detected in the vitreous fluid from the RE (1:679). A
laser barrier was placed around the
granuloma in the LE. After 1 month of
steroid therapy, a tapering schedule was started. At 6 months postoperatively, the fundi of both eyes were stable. The final best-corrected visual acuity was 8/20 in the RE and 20/20 in the LE.
CONCLUSIONS: A rare case of bilateral ocular
toxocariasis is reported with a different clinical presentation in each eye that was diagnosed using
enzyme-linked
immunosorbent assay analysis of intraocular fluids. Both eyes were successfully treated medically with a
vitrectomy eventually being required in the RE.