Orbital Cysticercosis: Clinical Manifestations, Diagnosis, Management, and Outcome Suryasnata Rath, MS, FRCS, 1 Santosh G. Honavar, MD, FACS, 1 Milind Naik, MD, 1 Raj Anand, MD, 1 Bhartendu Agarwal, MD, 1 Sannapaneni Krishnaiah, MPH, 2 G. Chandra Sekhar, MD, FRCS 1 Purpose: To describe the clinical manifestations, diagnosis, management, and outcome of orbital cysticer- cosis in a tertiary eye care center in Southern India. Design: Retrospective observational case series. Participants: A total of 171 patients with orbital cysticercosis. Methods: Retrospective case series involving consecutive patients with orbital cysticercosis from March 1990 to December 2001. Main Outcome Measures: Clinical resolution and significant residual deficit. Results: The median age at presentation was 13 years (range 2– 65 years), and 93 patients (54.4%) were male. The 3 main symptoms at presentation were periocular swelling (38%), proptosis (24%), and ptosis (14%) with a median duration of 2 (range 0 –24) months. The 3 main signs at presentation included ocular motility restriction (64.3%), proptosis (44.4%), and diplopia (36.8%). The cyst locations in the decreasing order of frequency were anterior orbit (69%), subconjunctival space (24.6%), posterior orbit (5.8%), and the eyelid (0.6%). In all, 80.7% of patients had cysts in relation to an extraocular muscle. The superior rectus (33.3%) was the most commonly involved extraocular muscle. Contact B-scan ultrasonography was diag- nostic of cysticercosis in 84.4% of patients. Orbital cysticercosis was managed medically in 158 of 166 patients. Although 149 patients received a combination of oral albendazole and prednisolone, 1 patient received oral albendazole alone, 7 patients received oral prednisolone alone, and 1 patient received oral praziquantel. Surgery was performed in 8 patients. Clinical resolution was seen in 128 of 138 patients (92.8%) at 1 month and 81 of 85 patients (95.3%) at 3 months. A significant residual deficit was present in 29 of 138 patients (21.0%) at the final follow-up and included proptosis in 7 patients, ptosis in 6 patients, ocular motility restriction in 3 patients, diplopia in 2 patients, strabismus in 2 patients, and a combination of the above in 9 patients. Conclusions: Orbital cysticercosis is a common clinical condition in the developing world. It typically affects young individuals and has a wide spectrum of clinical manifestations. Both B-scan ultrasonography and computed tomography scan are useful in confirming the diagnosis. Despite resolution of cysticercosis with medical management, a significant proportion of patients may have residual functional deficits. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2010;117:600 – 605 © 2010 by the American Academy of Ophthalmology. Cysticercosis is a parasitic infestation by Cysticercus cellulosae, which is the larval form of Taenia solium. It is endemic in regions with poor sanitation. Human infec- tion occurs by drinking contaminated water, eating un- cooked vegetables infested with eggs of the worm, and autoinfection. 1,2 The most common form of systemic involvement is neurocysticercosis. 1 Ocular and adnexal cysticercosis represents 13% to 46% of systemic dis- ease. 3 An earlier publication from India had reported ocular involvement in 12.8% of all cases of cysticercosis; the majority were located in the subconjunctival space, and only 1 case had orbital involvement. 4 Increased availability of imaging techniques has helped detect or- bital cysticercosis in the recent times. 5 This large case series describes the clinical manifestations, management, and outcome of orbital cysticercosis in a tertiary eye care center in Southern India. Patients and Methods A retrospective chart review was carried out of all consecutive patients with orbital cysticercosis presenting between March 1990 and December 2001. Orbital cysticercosis was diagnosed when any of the following was present: cyst with a scolex on imaging (B-scan ultrasonography or computed tomography scan), cystic lesion without a scolex on imaging with therapeutic response to anticysticercal therapy, or histopathologic examination of the ex- cised cyst showed cysticercosis. Data collected included age, gender, laterality, predominant symptoms and signs at presentation, referral diagnosis, prior treat- ment, and response to such treatment. Clinical examination details included presence and degree of proptosis, strabismus, motility limitation, diplopia, ptosis, and periocular swelling and eyelid edema. Clinical and differential diagnoses, serology, and results of imaging (B-scan ultrasonography and computed tomography scan) were documented. Standard medical management comprised oral albendazole 15 mg/kg body weight per day for 4 weeks and oral 600 © 2010 by the American Academy of Ophthalmology ISSN 0161-6420/10/$–see front matter Published by Elsevier Inc. doi:10.1016/j.ophtha.2009.07.030