Treatment of Ocular Toxocariasis
The recommended treatment for ocular toxocariasis is albendazole 400 mg twice daily for 2 weeks combined with corticosteroids, with joint management by an ophthalmologist. 1
Diagnosis and Clinical Presentation
- Ocular toxocariasis presents with visual changes, retinal granuloma, or uveitis, with eosinophilia being less common in isolated ocular disease 1
- Diagnosis is primarily through serology, with fundoscopic examination revealing whitish epiretinal lesions or scars 2, 3
- Optical coherence tomography may show elevated retinal surfaces and posterior acoustic shadowing of scars 2
Treatment Algorithm
First-line Treatment
- Albendazole 400 mg twice daily for 2 weeks combined with corticosteroids is the recommended regimen 1, 2
- Corticosteroid therapy (typically prednisolone 40-60 mg once daily) should be administered to control inflammation 1, 3
- Joint management with ophthalmology is essential for optimal outcomes 1
Treatment Protocol Details
- Some clinicians initiate corticosteroids (oral prednisolone 0.5-1 mg/kg/day) before or concurrently with albendazole to minimize inflammatory reactions 3
- For severe cases, higher doses of corticosteroids may be required, with triamcinolone being an alternative option (16 mg daily for 2 weeks, then 8 mg daily for 1 week) 2
- Treatment duration should be at least 2 weeks, with monitoring for clinical improvement 1, 4
Advanced or Complicated Cases
- In cases with significant vitreous involvement, intravitreal injections may be considered, similar to management approaches for other ocular parasitic infections 5
- Vitrectomy should be considered in cases with significant vitreous opacity or when fungal/parasitic abscesses are inaccessible to systemic agents 5, 3
- For cases with macular involvement, more aggressive therapy may be required 5
Monitoring and Follow-up
- Serial fundus examinations and optical coherence tomography should be performed to monitor treatment response 2, 3
- Combined albendazole and corticosteroid therapy has shown lower recurrence rates (17.4%) compared to corticosteroid monotherapy (54.5%) 3
- Visual acuity should be monitored before and after therapy to assess treatment efficacy 4
Special Considerations
- In children with idiopathic nephrotic syndrome, careful monitoring is required when administering albendazole (15 mg/kg/24h for 7 days) with concurrent increase in prednisone dosage 6
- Screening for potential co-infections (particularly Strongyloides) is recommended before initiating prolonged corticosteroid therapy to prevent hyperinfection 1
- Ocular toxocariasis may occur without systemic eosinophilia, making diagnosis challenging 1, 3
Prevention
- Risk for toxocariasis can be reduced by handwashing after soil contact, routine pet deworming, and appropriate disposal of pet feces 7
- Avoiding consumption of raw meat, especially raw cow liver, which has been significantly associated with ocular toxocariasis in adults (80.8% of cases vs. controls) 3