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A 64-year-old man with an unusual conjunctival cyst
Digital Journal of Ophthalmology 2017
Volume 23, Number 1
March 8, 2017
DOI: 10.5693/djo.03.2016.04.001
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Seanna Grob, MD, MAS | Department of Ophthalmology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts Department of Ophthalmology, Massachusetts Eye and Ear Infirmary
Daniel R. Lefebvre, MD | Department of Ophthalmology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts Department of Ophthalmology, Massachusetts Eye and Ear Infirmary Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
Nora Laver, MD | Ophthalmic Pathology, Department of Ophthalmology, Tufts Medical Center and Tufts University School of Medicine, Massachusetts
Mary K. Daly, MD | Department of Ophthalmology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts



Diagnosis and Discussion
The diagnosis was a subconjunctival cyst associated with a degenerated nematode, which has rarely been reported. Miller and Campbell reported a case of a subconjunctival cyst in a Simmental calf with 2 nematodes identified as Thelazia gulosa.(1) Ashton and Cook described allergic granulomatous nodules of the conjunctiva and eyelid, of which over half were caused by unidentified fragments of nematodes.(2) There are reports of live subconjunctival nematodes in patients from other countries or with a recent history of travel.(3)

Our patient may have been at risk for such an infection due to his interactions with wild animals and possibly due to his time in southern Florida. Dirofilaria tenuis and Dirofilaria immitus are endemic to southern Florida. D. tenuis is also harbored in raccoons in North America.(4) Fortunately, he had an isolated infection and never experienced symptoms or complications from the infection. Since the nematode was already dead, no other treatment was necessary. He was advised to avoid contact with wild animals and it was recommended that he obtain a rabies vaccination. Even if an isolated subconjunctival nematode is alive, surgical removal of the worm is often sufficient.(5) Nematode infections should be considered in patients with unusual behaviors that involve wildlife or if they have migrated from or traveled to endemic areas in the recent past. Thorough systemic evaluation is also recommended.
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