: Case of Filaria loa by Robertson Douglas Argyll - Filarial worms; Loaiasis

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CASE OF FILARIA LOA.

BY D. ARGYLL ROBERTSON, M.D., F.R.C.S.ED., OCULIST TO H.M. THE QUEEN IN SCOTLAND; PRESIDENT OF THE OPHTHALMOLOGICAL SOCIETY OF THE UNITED KINGDOM; LECTURER ON DISEASES OF THE EYE IN THE UNIVERSITY OF EDINBURGH, ETC.

LONDON: PRINTED BY ADLARD AND SON, BARTHOLOMEW CLOSE, E.C., AND 20, HANOVER SQUARE, W. 1895.

Communication read at the Meeting of the Ophthalmological Society on October 18th, 1894.

On the 29th of June last I was consulted by Miss J. H? on account of what she termed the presence of a worm in her eye.

She is a slightly anaemic, prematurely grey-haired, but otherwise healthy-looking lady, thirty-two years of age. She has resided at Old Calabar on the West Coast of Africa at intervals, for nearly eight years altogether. She twice had to return home on account of debility following severe intermittent fever. During her last visit to Old Calabar, which extended to about eighteen months, she suffered almost the whole time from chronic dysentery followed by severe remittent fever, which necessitated her return to this country last January in a very weak state of health.

She stated that the worm was first observed by her in February of this year, immediately after her return home. It frequented both eyes, but showed a preference for the left one, sometimes coursing over the surface of the eye under the conjunctiva, sometimes wriggling under the skin of the eyelids--causing a tickling, irritating sensation, but not real pain. It had latterly restricted its visits entirely to the left eye. On account of the remittent fever from which she was still suffering, her bedroom, when she first came home, was kept well heated, and until she recovered from the fever she noticed that the worm was particularly lively, occasionally causing the eye to become bloodshot, and the eyelids to swell and blacken slightly. As long as she was confined to warm rooms the worm was almost constantly moving about in the neighbourhood of the eye, causing such irritation as to prevent reading or work of any kind. This irritation with accompanying injection always passed off in the course of the day, and never resulted in severe inflammation.

When I first saw Miss H--, in June, I very thoroughly examined the eye, but failed to observe any trace of the parasite, unless perhaps the appearance of a minute bluish vesicle at the extreme outer angle of the conjunctival cul-de-sac corresponded to one of the extremities of the worm, but the vesicle, though watched for a time, did not alter in position or appearance. I gave her strict injunctions to return at any time whenever she felt the worm on the move.

I saw her twice at the eye wards of the Royal Infirmary about the beginning of July, but on these occasions careful inspection was again negative in its results.

On the 12th of September, however, she again came to the Infirmary, stating that she had felt the worm moving about in the left eye that forenoon, and to prevent it leaving the surface she had kept the eye well covered with a warm cloth till she made her way to the Infirmary. On this occasion, after examining the eye for a minute or two, I observed the worm moving in a tortuous, wriggling manner under the conjunctiva, the surface of which became slightly elevated as it moved along.

It passed with a pretty quick movement over the surface of the sclerotic at the distance of about 5 mm. from the outer margin of the cornea. It glided from the upper outer towards the lower outer part of the globe. There was increased lachrymation and slightly increased injection of the conjunctiva,--just such an appearance as would result from a particle of dust in the eye.

I at once placed my finger on the surface of the globe in such a manner as to prevent the parasite passing backwards until the conjunctiva was pretty well anaesthetised by the application of cocaine. I then got my friend Dr. Maddox, who was present, to apply his finger while the necessary preparations were hastily made for an operation.

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