Subconjunctival and Orbital (Twin) Cysticercosis in a Child

A seven-year-old Indian boy presented with a reddish mass over the outer part of right eye; the mass had been present for two months. It was associated with pain, discharge, and intermittent double vision. There was no history of ocular trauma, surgery, or any similar complaints. The patient was afebrile with no swelling over any other parts of the body. The ophthalmic examination revealed stretched right upper and lower eyelids, temporal displacement of the lateral canthus, and matting of the eyelashes. A well-defined, reddish yellow, oval mass measuring 15 × 12 mm was noted in the temporal quadrant of the right orbit. The overlying conjunctiva was stretched with prominent blood vessels and a distinctively yellow inferior segment [Figure1(a), arrow]. Conjunctival congestion was more prominent on the temporal surface of the mass [Figure 1(b)]. A mild restriction of abduction was observed. The rest of the right and left eye examination revealed all findings within normal limits.The B-scan ultrasonography of the right orbit revealed a highly echogenic structure within a hypoechoic cystic lesion inside the lateral rectus muscle belly [Figure 2(a)]. The axial scans of computed tomography (CT) showed a hyperdense spec inside a hypodense lesion over the anterolateral part of the right globe [Figure 2(b)] and a bulky lateral rectus belly containing another heterogenous lesion [Figure 2(c)]. The brain CT showed a healed granuloma in the left parietal lobe [Figure 2(d)]. The history, clinical features, and radiological features were suggestive of right twin-orbital myocysticercosis with healed neurocysticercosis. On retrospective history, there was a contributory history of frequent consumption of smoked pork.