Images in Clinical Medicine
N Engl J Med 2008; 359:e25November 13, 2008DOI: 10.1056/NEJMicm075735
A 49-year-old man presented to the emergency room with a 2-day history of decreased vision in his left eye. He described his vision as “looking through branches in a tree.” His visual acuity was 20/200 in the left eye, he had 1+ cells in the anterior chamber, and a dilated-fundus examination revealed linear and arcuate disturbances in the retina, which were most striking in the macula (Panel A). A fly larva was initially observed in the macula but had migrated out of view before retinal laser photocoagulation could be performed. After 4 days of treatment with thiabendazole, a repeat dilated-fundus examination revealed a segmented fly larva in the vitreous (Panel B). The patient elected to undergo vitrectomy. Eight weeks after the vitrectomy, the lesions in the retina were attenuated and the visual acuity had improved to 20/40. The patient had no travel history. Adult flies may have deposited either eggs or tiny larvae on the patient's hands; the eggs or larvae may then have been transported to the eye, where larvae invaded the tissue to feed and grow.
Michael A. Albert, Jr., M.D.
Retina Consultants of Alabama, Birmingham, AL 35233
Jill R. Wells, M.D.
University of Alabama at Birmingham, Birmingham, AL 35294