1120-6721/683-03$25.00/0 © Wichtig Editore, 2009 European Journal of Ophthalmology / Vol. 19 no. 4, 2009 / pp. 683-685 SHORT COMMUNICATIONS & CASE REPORTS Palpebro-orbital myiasis in a patient with basal cell carcinoma JOSE M. ABALO-LOJO 1 , MARÍA J. LÓPEZ-VALLADARES 1 , J. LLOVO 2 , ABEL GARCIA 3 , FRANCISCO GONZALEZ 1,4 1 Service of Ophthalmology 2 Service of Microbiology, Complejo Hospitalario Universitario de Santiago de Compostela 3 Service of Maxilofacial Surgery and Department of Surgery, Complejo Hospitalario Universitario de Santiago de Compostela, University of Santiago de Compostela 4 Department of Physiology, School of Medicine, University of Santiago de Compostela - Spain PURPOSE. We report a patient with basal cell carcinoma presenting with severe myiasis in a large ulcer involving the upper and lower eyelid. METHODS. Myiasis is an infestation of vertebrate animals by larvae of certain fly species. About 70 lar- vae were removed manually. A biopsy of the tissue underneath demonstrated a basal cell carcinoma. The myiasis was produced by the fly Lucilia sericata, currently used for treating chronic nonhealing ulcers. Because of the stage of the carcinoma, an orbital exenteration was carried out. RESULTS. The patient died 2 days later because of cardiopulmonary failure not related to the myiasis. CONCLUSIONS. We present a case of a severe orbital myiasis focusing on its management and life- threatening nature. (Eur J Ophthalmol 2009; 19: 683-5) KEY WORDS. Basal cell carcinoma, Larvae, Lucilia sericata, Orbital myiasis Accepted: January 11, 2009 Case reports An 85-year-old man with a history of mental illness and other relevant past medical history presented to the emer- gency room of our hospital with severe pain and burning in the left orbital region. The patient was dehydrated, cachec- tic, and in poor hygienic condition. He was disoriented in time, space, and person. The initial examination of the left eye revealed a large ulcer involving the upper and lower eyelid with periorbital edema extending to the forehead. By external inspection, the eye- ball was not visible. There were a large number of white and shiny larvae crawling over the fleshy mass (Fig. 1). The right eye was normal. An orbital computed tomography (CT) scan was made to rule out the possibility of exten- sion to anterior cranial fossa. The scan revealed soft tissue swelling without bony erosion and upper displacement of the ocular globe. A few larvae were collected for further study and under local anesthesia and irrigation with diluted metronidazole, the remaining visible larvae (about 70) were manually re- moved using a forceps and the lesion was cleaned. Sterile dressing was applied and systemic antibiotics and analge- sics were given. CT scan and magnetic resonance imaging after the larvae removal showed the displaced eyeball, with cavitations in the most anterior part of the ocular tissues (Fig. 2). Chest x-ray revealed a left lung mass that was sus- pected of being pneumonia. The larvae were identified as a Lucilia sericata, order Diptera, family Calliphoridae. A biopsy of the edge and fundus of the lesion showed a basal cell carcinoma. An exenteration was performed and the pathology examination demonstrated orbital extension of the lesion, preserved eyeball, and no evidence of normal tissue invasion by the larvae. After surgery, the patient un- derwent progressive systemic impairment and finally died because of cardiopulmonary failure unrelated to the oph- thalmic condition.