Diagnosis of ophthalmomyiasis externa by dermatoscopy

Ophthalmomyiasis in humans caused by the larvae of the sheep nasal botfly (Oestrus ovis) and is a rare phenomenon in Israel. We describe the utilization of the dermatoscope as a diagnostic tool for the facilitation of early diagnosis of conjunctivitis due to the infestation of the eyes by the sheep nasal botfly in two patients. After the physical removal of the larvae with the help of a cotton swab applicator under a slit lamp examination and the topical use of antibiotics, the clinical symptoms improved within 1–2 days. Undoubtedly the dermatoscope played a crucial role leading to the definitive diagnosis and immediate therapeutic intervention.


Introduction
Ophthalmomyiasis, also known as ocular myiasis, is the infestation of the eye or periorbital tissue by larvae of the insect order Diptera. When larvae remain outside the eye it is called ophthalmomyiasis externa, while penetration of the eye is termed ophthalmomyiasis interna. The latter is caused by the larvae of Dermatobia hominis, which can cause also blindness. Ophthalmomyiasis externa in humans is often caused by the larvae of the sheep nasal botfly, Oestrus ovis, and the Russian botfly, Rhinoestrus purpureus, which are found in sheep farming communities. Often the victims have the sensation of being struck by a foreign body or insect. Soon thereafter a painful inflammation develops, causing an acute catarrhal conjunctivitis [1,2].
Oestrus ovis is a cosmopolitan fly whose females are larviparous, depositing a number of first instar larvae on the edge of, or just inside the nostrils of sheep and goats, while still in flight, whereas infestation in humans is rare [3].
Ophthalmomyiasis produced in humans by O. ovis larvae is restricted to conjunctivae, sclera, eyelids, and lacrimal duct (external ophthalmomyiasis) or the eyeball (internal ophthalmomyiasis). Hallmarks of this condition are a typical history associated with severe local conjunctival inflammation with

Diagnosis of ophthalmomyiasis externa by dermatoscopy
Ophthalmomyiasis in humans caused by the larvae of the sheep nasal botfly (Oestrus ovis) and is a rare phenomenon in Israel. We describe the utilization of the dermatoscope as a diagnostic tool for the facilitation of early diagnosis of conjunctivitis due to the infestation of the eyes by the sheep nasal botfly in two patients. After the physical removal of the larvae with the help of a cotton swab applicator under a slit lamp examination and the topical use of antibiotics, the clinical symptoms improved within 1-2 days. Undoubtedly the dermatoscope played a crucial role leading to the definitive diagnosis and immediate therapeutic intervention.

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Observation | Dermatol Pract Concept 2014;4(4):19 of the organisms precluded their removal under these conditions and therefore the patient was referred for a slit lamp examination at the emergency department of Beilinson Hospital, where 14 additional larvae were removed from the eye.
The patient was released after application of chloramphenicol eye ointment with ocular covering.
The following day he reported a sensation of something moving in the left posterior nasal region later migrating to the back of his throat. After intensive water gargling, all symptoms resolved and the eye recovered without any further sequelae.

Case 2
A 17-year-old teenager arrived at the clinic after spending the prior night and day hiking the Hevron mountains. He In Israel, cases of ophthalmomyiasis caused by O. ovis have been reported [7][8][9]. In addition, Yeruham et al. [10] reported the case of a pharyngeal myiasis, while Mumcuoglu and Eliashar [11] reported a case of nasal myiasis caused by the larvae of this species.
We describe the utilization of the dermatoscope as a diagnostic tool for the facilitation of early diagnosis of conjunctivitis due to the infestation of the eyes by the sheep nasal botfly in two patients. Dermatoscopy for use over the various surfaces of the body holds a vast number of advantages. In particular, the numerous uses of polarized dermatoscopy in ophthalmology have been reported [13,14]. For instance, a portable utensil in its format, as opposed to the slit lamp which is static and demands the patient sit in front of the examiner, will enable patient examination while lying on a bed. This is a great benefit specifically for subjects who react with fear to discomfort and eye manipulation and procedures with vasovagal syncopal reactions [15]. This is the first report of dermatoscopic use in diagnosis of this condition. Slit lamp is the rule for diagnosis of ophthalmomyiasis in all reports in the past [16]. The consequences of a late and delayed diagnosis are obvious, therefore the clinical approach noted in previously