PMC4759505_01
(a) Slit lamp images showing live cysts. (b) The black arrow shows the sucker on scolex head. (c) Mutton fat keratic precipitates seen on slit lamp. (d) Ruptured cyst wall with large floating cyst.
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The grayish white cysts were neither attached to the iris nor to the cornea or lens capsule and were freely floating in the anterior chamber (Fig. 1a). The cyst showed characteristic undulating, contracting and expanding movements along with protrusion and retraction of scolex head from the cyst (Fig. 1b). Mutton fat keratic precipitates (KP's) were present along with grade 3 flare (Fig. 1c). When the scolex was invaginated, its location within the cyst was indicated by a dense white spot called the receptaculum capitis while when evaginated it made pendulous movements (Fig. 1d). On the second day, one of the cysts was ruptured and ruptured cyst wall was seen in anterior chamber along with large floating cyst (Fig. 1d).
(a) Cystic lesions with irregular thin echogenic membrane. (b) Gross photograph of cyst after H & E stain. (c) $, # & * denote head, sucker and body of scolex (20x). (d) $ and # denote the head and sucker of scolex (200x).
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Ultrasonography of the orbits showed small cystic lesions of size 2.9 x 2.6 mm in anterior chamber of right eye on, lateral side with irregular thin echogenic membrane along anterior surface of the iris (Fig. 2a). It was fixed in 10% formalin and stained with haematoxylin and eosin (Fig. 2b). Histopathologically, the specimen demonstrated a scolex and a membranous cyst wall, thus confirming it was a cyst of cysticercus cellulosae (Fig. 2c and d).
(a) Keratic precipitates completely cleared on post-op. (b) No inflammation seen on second post-operative day.
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By the second post-operative day, the mutton fat keratic precipitates had completely cleared and the vision was 6/12 in the right eye, with no cells or flare in anterior chamber (Fig. 3a and b).