Outcome of medical management of orbital parasitic mass

Abstract

Aim of the Study: To study the efficacy of medical management in orbital parasitic lesions. Patients and Methods: A retrospective chart review of 25 consecutive patients with orbital parasitic mass between May 2015 and June 2016. Data were collected and analyzed. Standard medical management of oral albendazole in the dose of 15 mg/kg weight twice a day for 2 weeks and then once a day for another 2 weeks along with oral corticosteroids 1 mg/kg body weight tapered over 4 weeks. Surgical excision planned only in patients with unresolved/residual masses. All the patients were followed up periodically. Main outcome measures were clinical resolution. Observations and Results: The mean age at presentation was 40 years, and 15 (60%) were female. All patients had unilateral involvement. The left eye was involved in 15 (60%) patients. All patients presented with lid edema. Some patients presented as itching, periorbital edema, and redness, chemosis, or proptosis. Among 25 patients, 18 (72%) patients, presented with preseptal mass,5 (20%) with postseptal mass and 2 (8%) with Subconjunctival mass. 12 (48%) patients had diabetes. Absolute eosinophil counts were within normal limits. Eighteen (72%) patients treated with combination therapy responded well with no residual mass. Surgical excision was done for seven patients (persisting 3 [12%], residual mass 2 [8%], and primary excision 2 [8%]) followed by combination therapy. First week of follow-up mass showed a mild reduction in size, along with surrounding edema, itching, and chemosis; in 2nd week, all patients reported significant improvement in signs and symptoms; in 4th week, no mass was palpable, soft tissue thickening of skin was noted which disappeared gradually over weeks. Conclusion: Various parasitic infections are important causes of ophthalmic disease worldwide. Kerala is considered as endemic for dirofilariasis due to the climatic conditions and the presence of suitable vectors species.[4] Parasitic orbital mass, should be included as a differential diagnosis for orbital mass. A trial of medical management with oral albendazole and corticosteroids merits consideration as first line of therapy over primary excision in all clinically diagnosed orbital parasitic mass.