First case of heterochthonous subconjunctival dirofilariasis described in Poland.

A 55-year-old Polish male presented with discomfort, redness, itching, and swelling in the left eye that had begun three days before seeking medical help. Slit-lamp examination revealed an actively moving subconjunctival worm located inferotemporally (Figure 1). A complete, live, moving nematode was removed under local anesthesia, and it was first stored in physiological saline for microscopic examination and then, put into 70% alcohol with glycerin and submitted for parasitological identification. The diagnosis was based on the following morphological features of the parasite: body length = 85.1 mm; maximum body width = 0.545 mm; esophagus = 0.895 mm long; vulva a little behind the esophagus; tail = 0.10 mm long, almost terminal; and cuticle with longitudinal combs on the surface (Figure 2). The worm was identified as an immature female nematode of the species Dirofilaria repens (Onchocercidae). The patient's blood tests were within the normal limits. Neither eosinophilia nor microfilaremia were detected.

Figure 1.

An immature female worm of Dirofilaria repens located subconjunctivaly with accompanying chemosis. This figure appears in color at www.ajtmh.org.

Figure 2.

An 85.1-mm-long and 0.545-mm-wide immature female worm removed from the subconjunctival nodule. This figure appears in color at www.ajtmh.org.

The infection with ocular dirofilariasis probably occurred during a visit to Greece 8 months before the symptoms occurred.1 However, because of recent reports of new endemic areas of dirofilariasis in countries conterminous to Poland, an autochthonic infection cannot be excluded.2

The differential diagnosis of subconjunctival filariasis should include loaiasis.