Pushker et al developed an algorithm for management of orbital or adnexal cysticercosis. The authors are from the All India Institute of Medical Sciences in New Delhi.
Accessible cysts (subconjunctival, eyelid, lacrimal gland) can be excised.
Chemotherapy with oral albendazole and steroids is done for:
(1) cystic lesion with scolex in the extra-ocular muscles
(2) cystic lesion without scolex in the extra-ocular muscles with positive ELISA test
(3) diffuse myositis of the extra-ocular muscles with positive ELISA test
(4) cystic lesion without scolex in the extra-ocular muscles with negative ELISA test and failure to respond to oral steroid therapy
• Using the enzyme-linked immunoelectrotransfer blot (EITB) assay is more reliable than the ELISA, so is preferred if available.
If the patient has diffuse myositis of the extra-ocular muscle and a negative ELISA, then a trial with oral steroids is made.
(1) If the patient responds then the diagnosis of idiopathic myositis is made.
(2) If the patient does not respond then the muscle is biopsied.
The best treatment for optic nerve involvement is uncertain. Some recommend surgery (which can be technically difficult) while others recommend chemotherapy (which may have a poor outcome).
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Specialty: Infectious Diseases