Veterinary Ophthalmology (2006) 9, 4, 259–264

Blackwell Publishing Inc

CASE REPORT

Pars plana vitrectomy for the treatment of ophthalmomyiasis interna

posterior in a dog
F. J. Ollivier,* K. P. Barrie,* R. N. Mames,† M. E. Kallberg,* E. C. Greiner,‡ C. E. Plummer,* K. N. Gelatt,*
D. T. Strubbe*§ and D. E. Brooks*
*Departments of Large and Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA; †The Retina Center,
Gainesville, FL, USA; ‡Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA; §Animal
Eye Specialist Clinic, Stuart, FL, USA

Address communications to: Abstract

Franck J. Ollivier Unilateral chorioretinitis caused by ophthalmomyiasis interna posterior in a
Tel.: (352) 392–4700
5-month-old, female spayed Dachshund is reported. Larva removal by pars plana
Fax: (352) 392 6125 vitrectomy was performed after an unsuccessful photocoagulation of the organism. The
e-mail: larva was intact after surgical removal and was identified as a first stage instar Cuterebra
ollivierf@mail.vetmed.ufl.edu
spp. larva. The eye remains visual and comfortable with no signs of residual or recurrent
inflammation postoperatively. This report describes, for the first time, the successful
surgical retrieval of an intravitreal fly larva in a dog using vitrectomy techniques without
sacrificing either the globe or vision, and taxonomic identification of the parasite.
Key Words: chorioretinitis, Cuterebra, dog, ophthalmomyiasis interna posterior, pars
plana vitrectomy

iridocyclitis and a mobile organism in the vitreous. The

INT RO DUC T IO N
Ophthalmomyiasis refers to invasion of the eye by parasitic
larval stages of certain Diptera. Ophthalmomyiasis can be
divided into external (i.e. presence of the larva in the orbit
and the accessory organs of the eye) and internal (i.e. pres-
ence of the larva within the globe) types, with the internal
form subdivided into infestations of the anterior and poste-
rior segments of the eye.1,2 Ocular invasion by insects has
been reported in cattle, sheep, horses, deer, cats, dogs and
humans.1–6 This is a report of Cuterebra spp. retrieved from
the posterior segment of a 5-month-old, female spayed
smooth Miniature Dachshund. The clinical signs, diagnosis
and treatment are described. To our knowledge, this is the
first report of the successful surgical removal of an insect larva
from the vitreous in a dog, and the subsequent taxonomic
identification of the larva.
CA SE REPO RT
A 5-month-old, female smooth Miniature Dachshund was
presented to a veterinarian for a constricted right pupil. The
dog was referred to a veterinary ophthalmologist for possible
early cataract in the right eye (OD). After ophthalmic exam-
ination, the veterinary ophthalmologist observed a mild
diagnosis of ophthalmomyiasis interna posterior was made.
A diode laser photocoagulation of the parasite was attempted
but the procedure was unsuccessful due to the lack of pigment
of the targeted parasite. The animal was treated with pred-
nisone (Prednisone 5 mg, Westward Pharmaceutical Corp,
Eatontown, NJ, USA) at 0.5 mg/kg, per os q24 h and 1%
prednisolone acetate OD q24 h (Prednisolone acetate 1%
ophthalmic solution [o.s.], Alcon, Fort Worth, TX, USA) and
then referred to the University of Florida Veterinary Medical
Center (UFVMC) for surgical extraction of the larval parasite.
On presentation to the UFVMC the dog acted normally
with no signs of ocular pain and no ocular discharge. Menace
response, palpebral, and direct and indirect pupillary light
reflexes were normal in both eyes (OU). The left eye (OS)
was normal in appearance. Schirmer tear test values were
within normal values (19 mm/min OD and 15 mm/min OS).
Fluorescein stain retention was negative. Intraocular pressure
(IOP) measurements by applanation tonometry (Tonopen
XL®, Biorad Mentor Ophthalmics, Norwell, MA, USA)
following topical anesthesia (Proparacaine HCl 0.5% o.s.,
Bausch & Lomb, Tampa, FL, USA) were 14 mmHg OD and
16 mmHg OS. Slit-lamp biomicroscopy (SL-14 Portable
Slit Lamp, Kowa Company, Ltd, Tokyo, Japan) revealed no
anterior segment abnormalities OU. The fundus examination

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260         E T A L.
Figure 1. Fundus photograph at the initial presentation at the
UFCVM. A white immobile larva can be observed in the posterior
vitreous (yellow arrow) (b) as well as vitreal and subretinal hemorrhages
(a, b). The subretinal curvilinear tracts are pronounced throughout the
tapetal and nontapetal retina (a, b). Chorioretinitis was present (a, b).
by indirect ophthalmoscopy (Omega 150 binocular indirect
headset, Heine, Germany and Double aspheric 20D lens,
Volk Optical Inc., Mentor, OH, USA) after instillation of a
mydriatic (Tropicacyl® 1% o.s., Bausch & Lomb) was nor-
mal OS. Indirect ophthalmoscopy OD revealed an immobile
white larva in the posterior vitreous at 8 o’clock, intravitreal
and subretinal hemorrhages and subretinal curvilinear tracts
throughout the tapetal and nontapetal retina (Fig. 1). There
were some newly formed hemorrhages since the initial
examination and the laser treatment performed by the refer-
© 2006 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 9, 259–264
Figure 2. Intraoperative photograph of the larva in the posterior
vitreous just before its removal.
ring veterinary ophthalmologist (Fig. 1). The diagnosis of
ophthalmomyiasis interna posterior associated with chori-
oretinitis in the right eye was confirmed and surgery was
recommended as the parasite was still causing active ocular
disease. Larval extraction by a pars plana vitrectomy was
recommended to resolve the condition.
Pre-anesthetic blood work (CBC and serum chemistry
panel) was within normal limits. The dog was maintained on
systemic prednisone (0.5 mg/kg PO, q24 h) in order to
control the uveitis and pain, and topical 1% prednisolone
acetate OD q4 h to treat the existing uveitis and the one that
would be induced by the surgery. Amoxicillin with clavulonic
acid at 14 mg/kg PO q12 h (Clavamox® 125 mg tablets,
Pfizer, Exon, PA, USA) was administered in order to prevent
infection. Topical triple antibiotic OD q6 h (Neomycin and
Polymyxin B sulfates and Gramicidin o.s., Bausch & Lomb)
was also administered to prevent ocular infection, and 1%
tropicamide OD q6 h to dilate the pupil in order to view the
posterior segment during surgery and to prevent synechiae
after surgery. After premedication with acepromazine at
0.05 mg/kg IM (Acepromazine, Phoenix Pharamaceutical
Inc., St Joseph, MO, USA) and buprenorphine at 0.02 mg/kg
IM (Buprenorphine, Reckitt Benckiser, Richmond, VA,
USA), general anesthesia was induced with thiopental at
10 mg/kg IV (Pentothal®, Abbott, Chicago, IL, USA) and
maintained by inhalation of isoflurane (Isoflo®, Abbott)
vaporized in oxygen delivered via a pediatric circle system.
The dog was placed in dorsal recumbency and the periocular
skin was prepared for surgery by clipping and washing the
skin with 1 : 50 povidone-iodine solution (Triadine®, Triad
Disposables Inc., Brookfield, WI, USA); the dilute povidone-
iodine solution was also used to cleanse the conjunctival
surfaces, followed by an eyewash flush. Paralysis was achieved
                                                                           261

Figure 3. Fundus photograph 8 months after the

surgical removal of the larva. The subretinal
curvilinear tracts throughout the tapetal and
nontapetal retina are still visible but the
chorioretinitis, vitreal and subretinal hemorrhages
have resolved (a, b).

Figure 4. Microphotograph of the larva that was

identified as Cuterebra spp. The larva presents the
characteristic morphologic features: body shape,
size and segmentation, characteristic band of black
spines lining the anterior border of each segment
(a: ×100). The black cuticular spines can be
observed at high magnification (b: ×400).

with atracurium besylate at 0.1 mg/kg IV (Atracurium,
Baxter, Caguas, PR, USA) to allow central positioning of
the globe. The surgery was performed under an operating
microscope. An 8-mm, temporary canthotomy was made at
the lateral canthus OD to better expose the globe. A wire lid
speculum was placed to maintain an open palpebral fissure.
The conjunctiva was dissected circumferentially from the
7 to the 3 o’clock position (290 degrees peritomy), 2 mm
posterior to the limbus.7,8 Blunt dissection was performed
posteriorly to expose 8 mm of sclera behind the limbus,
avoiding the extra-ocular muscles. The sclerotomy sites were
located 5.5 mm from the limbus at 8.30 o’clock, 4.5 mm from
the limbus at 10 o’clock and 5.5 mm from the limbus at
2 o’clock.7,8 Wet field cautery was used to cauterize sclerotomy
sites, and scleral incisions were made using a 20-gauge micro-
vitreoretinal blade (MVR Blade, BD Ophthalmics, Franklin
Lakes, NJ, USA). A 20-gauge infusion port to deliver balanced
salt solution was placed into the 8.30 o’clock position to
maintain pressure in the eye throughout the surgery. The
infusion port was secured in place with a preplaced 6–0 poly-
glactin 910 (Vicryl®, Ethicon Inc., Somerville, NJ, USA)
mattress suture. The 10 and 2 o’clock incision sites were tem-
porarily plugged with stainless steel plugs. The stainless steel
plugs were taken out and a light port was placed at the 2 o’clock
position and the vitreous cutter was introduced through the
10 o’clock port. A Machemer lens (Machemer vitrectomy lens,
Bausch & Lomb) was placed on the cornea with a slow Lac-
tated Ringer Solution drop to allow view of the posterior
segment (Fig. 2). The vitrector (Storz premier unit vitreous
cutter, Storz ophthalmics, St Louis, MO, USA) was used to
cut and aspirate the anterior vitreous in order to reach the
larva now located at 7 o’clock. Intraocular forceps were then
placed into the 10 o’clock port and used to grasp the para-
site. The larva was then placed in 10% formalin and later
submitted for identification. A vitrectomy was performed
under each incision site in order to reduce the chance of
inflammatory traction bands and therefore minimize the risk
of retinal detachments. The sclera was sutured with 7–0 poly-
glactin 910 with a single cruciate mattress suture placed at each
incision site. The conjunctiva was repositioned and sutured
with 8 –0 polyglactin 910 in a simple interrupted pattern.
The conjunctiva (deep layer) of the lateral canthotomy was

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262         E T A L.
sutured with a continuous suture using a 8–0 polyglactin
910. The skin was closed with 5–0 nylon (Ethilon®, Ethicon
Inc.) in a simple interrupted pattern. The anterior chamber
was of normal depth at the end of the surgery. A partial tem-
porary tarsorrhaphy was placed in the medial canthus using
5–0 nylon, closing one-half of the palpebral fissure. The
dog recovered from paralysis and anesthesia uneventfully.
An Elizabethan collar (Buster® collar, Butler, Denmark) was
placed on the dog to prevent self-trauma for 3 weeks.
One day postoperatively, the patient appeared comforta-
ble and visual. There was moderate to severe conjunctival
and scleral hyperemia near the surgery site OD. There was a
mild uveitis with the anterior chamber of normal depth and
1+ aqueous flare. The IOP was 11 mmHg OD and 14 mmHg
OS. No fluorescein stain retention was observed OU. The
dog was discharged on systemic prednisone (0.5 mg/kg PO,
q24 h) for 5 days, amoxicillin with clavulonic acid at 14 mg/kg
PO, q12 h (Clavamox® 125 mg tablets, Pfizer) for 10 days,
topical 1% prednisolone acetate OD q4 h, triple antibiotic
OD q6 h (Neomycin and Polymyxin B sulfates and Gramicidin
o.s., Bausch & Lomb) and 1% tropicamide OD, q6 h.
One week postoperatively, the patient appeared comfort-
able and visual. There was moderate conjunctival and scleral
hyperemia near the surgery site OD. There was a mild uveitis
with the anterior chamber of normal depth and 1+ aqueous
flare. The IOP was 6 mmHg OD and 7 mmHg OS. No
fluorescein stain retention was observed OU. The dog was
discharged on systemic prednisone and amoxicillin with
clavulonic acid as previously prescribed. Topical 1%
prednisolone acetate OD was reduced to q6 h and 0.03%
flurbiprofen was added OD q8 h (Flurbiprofen 0.03% o.s.,
Pacific Pharma, Irvine, CA, USA); triple antibiotic and 1%
tropicamide were continued as prescribed.
Two weeks postoperatively, the patient appeared comfort-
able and visual with minimal conjunctival and scleral hyper-
emia near the surgery site OD. There was no sign of uveitis.
The IOP was 8 mmHg OU. No fluorescein stain retention
was observed OU. The dog was discharged on systemic
prednisone for 7 additional days, after which prednisone
was discontinued. Topical 1% prednisolone acetate OD was
maintained at q6 h, and the flurbiprofen, triple antibiotic
and 1% tropicamide were discontinued.
One month postoperatively, the patient appeared com-
fortable and visual. The conjunctival and scleral hyperemia
had resolved OD. There was no sign of intraocular inflam-
mation OD. The IOP was 10 mmHg OD and 8 mmHg OS.
No fluorescein stain retention was observed OU. Topical
1% prednisolone acetate OD was reduced to OD q12 h for a
week, then q24 h for 2 weeks, and then discontinued.
Eight months postoperatively, the patient was comforta-
ble and visual with no signs of ocular inflammation OD
(Fig. 3). The IOP was 15 mmHg OD and 17 mmHg OS.
No fluorescein stain retention was observed OU. The dog
was no longer on any treatment.
Because the parasitic specimen was intact after its surgical
removal, taxonomic identification was possible. The larva
© 2006 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 9, 259–264
was identified by our parasitologist (ECG) as a first instar
larva of Cuturebra spp. based on characteristic morphologic
features: body shape, size, band of black spines lining the
anterior border of each segment (Fig. 4).
D IS C U S S I O N
Ophthalmomyiasis can be divided into external and internal
infestations, with the internal form subdivided into anterior
and posterior types depending on the region of the eye
affected. Ocular invasion has been reported in cattle, sheep,
horses, deer, cats, dogs and humans.1–6,9
The mode of entry of the larva into the eye is unknown in
most instances, but is usually postulated to be through the
corneal or conjunctival surfaces. The organism may also
enter and exit through the optic nerve, bloodstream, or by
direct penetration of the sclera. It is very rare that a larva is
observed alive in the eye as in this dog case report,2,6 and in
most cases of ophthalmomyiasis the larvae have not been
recovered for taxonomic identification.1,2 In eight reported
cases of ophthalmomyiasis interna in cats, six were post-
erior1,2,5,6 and the species of larva was only identified as a
third or fourth stage instar Cuturebra spp. larva in one case.5
The two remaining cases were of an ophthalmomyiasis
interna anterior caused by a first stage instar larva of Cuturebra
spp.3,4 In the two reported cases in dogs, the animals had an
ophthalmomyiasis interna posterior and the species of larva
was not identified.2,6
It is important to know the life cycle of Cuturebra spp. to
explain the manner in which cats and dogs become incidental
hosts to the larva. Cuterebra spp. (Diptera, family Cuterebridae)
is the larva of a rodent or rabbit bot fly. Adult Cuterebra are
nonparasitic and are seldom observed. All Diptera pass
through comparable developmental stages in their life cycle
and most of them are oviparous. Adult female flies lay
hundreds of eggs (as many as 2000 eggs, 5–15 per site) on
vegetation surrounding the burrows of their natural hosts,
rodents and lagomorphs.3,5,9,10 Stimulated by the tempera-
ture and moisture when exposed to the warmth of the host,
the larvae develop within the egg, and hatch a motile, infective
1-mm-long first instar larvae. When a host is encountered,
the larva attaches and enters the host orally, through the
nares or other natural body orifices, or wounds. After enter-
ing the host, they migrate to various locations, most com-
monly to subcutaneous regions, but this is variable. They
molt their entire exoskeleton two times while progressing
from first to third larval instar stages.3,5,10 All instar stages
have morphologic characteristics which change through
metamorphosis. Most taxonomic keys to these larvae are
based on third larval stage, and identification of the first
instar is difficult. The larvae, in their normal hosts (i.e.
rodents and rabbits), grow to reach an ultimate length of 1–
3 cm and a diameter of 10 mm. Black cuticular spines give
fully developed larvae a dark color. The larva takes approxi-
mately 4 weeks to develop. They usually mature within a
thick-walled, subcutaneous abscess of the host. Purulent
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exudate may exit from the cutaneous entry hole, which also
serves as a breathing hole. The life cycle continues with the
larva exiting the abscess to pupate in the soil. Pupation time
varies depending on environmental factors. Dogs and cats
may become infested, possibly by exploring the burrows of
the natural host, as was hypothesized to be the manner of
infestation in this case report.
Aberrant larval migration may occur, including invasion
of the eye and the brain resulting in central nervous system
lesions.1–6,11,12 Affected animals are most commonly pre-
sented in July through to September.5,11,12 As mentioned
earlier, entry to the globe is still speculative. The reported
sequelae to ocular invasion by dipterous larva include
obstruction of vision by either living or dead larva in the
anterior chamber or vitreous; ocular pain; conjunctivitis;
blurred vision secondary to uveitis, and sudden blindness
resulting from invasion of the optic nerve; retinal and vitreal
hemorrhages; subretinal curvilinear, criss-crossing tracts;
and retinal detachment. The host reaction to the larval
presence seems to vary. The signs and prognosis probably
depend upon the viability of the larva and its location within
the eye rather than on its identity.1,2 In humans, posterior
involvement is most common and ocular manifestations have
varied from benign subclinical disease to panophthalmitis.
The human cases of presumed ophthalmomyiasis interna are
subclinical and diagnosed when linear and arcuate criss-crossing
tracts of the retina are observed on routine retinal examina-
tion. The characteristic tracts have been attributed to toxic
or mechanical disturbance of the retinal pigment epithelium
during the migratory activity of the larvae. Preretinal and
choroidal hemorrhages, and chorioretinitis are observed in
the acute phase.2,13,14 Reports in the veterinary literature of
ophthalmomyiasis are similar to those reported in humans.
It appears that the presence of the larva in the anterior segment
of the eye (i.e. ophthalmomyiasis interna anterior) induces a
more severe inflammatory reaction than its presence in the
posterior segment (i.e. ophthalmomyiasis interna posterior).1,3–5
It also appears that a severe inflammatory reaction develops
more often following the death of the larva;3,9,10 however, the
destruction of the larvae by laser photocoagulation does not
seem to induce a significant inflammatory response.15–17
Histologically the optic nerve, retina and choroid demon-
strate coagulation necrosis and hemorrhage (hemorrhagic
infarction) in cases of ophthalmomyiasis interna posterior
and a mild to moderate subacute fibrinous and eosinophilic
anterior uveitis in cases of ophthalmomyiasis interna anterior.5
The host reaction to the larval presence varies; therefore,
the ocular signs also vary. The therapy, either medical and/
or surgical, should be chosen according to the ocular signs
observed in the presence of the intraocular parasite. If sub-
stantial intraocular inflammation is present with internal
myiasis, the initial therapy should include corticosteroids. If
the larva is alive and the eye is not inflamed, cautious obser-
vation for spontaneous migration from the eye may be
elected. Photocoagulation of the living larva by laser is the
treatment of choice. This treatment halts additional damage
© 2006 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 9, 259–264
from further larval migration.3,4,6,17 The use of the laser
results in minimal inflammation because the laser energy
denatures the organism’s proteins resulting in diminished
antigenic stimulation.3,4,15,16 If the larva is dead or immobile
and causing inflammation in the face of medical treatment, it
should be surgically removed.2,3,9,18,19 Pars plana vitrectomy
has been successful to remove intraocular parasites from the
vitreous.9,18,19 Also, various systemic insecticides (organo-
phosphates) may be effective in killing the larva. There is,
however, a potential for an immune response to the dead larvae,
and this reaction must be considered prior to initiating
larvacidal therapy.1,6
This is the first reported instance in which a dipteran larva
was taxonomically identified, having being successfully removed
from the posterior segment of the eye of a dog, with reten-
tion of vision.
R E FE R E N C E S
1. Brooks DE, Wolf ED, Meridith R. Ophthalmomyiasis interna in
two cats. Journal of the American Animal Hospital Association 1984;
20: 157–160.
2. Kaswan RL, Martin CL. Ophthalmomyiasis interna in a dog and
cat. Canine Practice 1984; 11: 28 –34.
3. Harris BP, Miller PE, Bloss JR et al. Ophthalmomyiasis interna
anterior associated with Cuterebra spp. in a cat. Journal of the Amer-
ican Veterinary Medical Association 2000; 216: 352–355.
4. Johnson BW, Helper LC, Szayerski ME. Intraocular Cuterebra spp.
larva in a cat. Journal of the American Veterinary Medical Association
1988; 193: 829– 830.
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8. Smith PJ, Penea L, Mackay EO et al. Identification of sclerotomy
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12. Hendrix CM, Cox NR, Clemons-Chevis CT et al. Aberrant intrac-
ranial myiasis caused by larval Cuterebra infection. Compendium
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13. Edwards KM, Meredith TA, Hagler WS et al. Ophthalmomyiasis
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Journal of Ophthalmology 1995; 4: 512–514.
15. Fitzgerald CR, Rubin ML. Intraocular parasite destroyed by photo-
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16. Forman AR, Cruess AF, Benson WE. Ophthalmomyiasis treated by
argon-laser photocoagulation. Retina 1984; 4: 163 –165.
17. Phelan MJ, Johnson MW. Acute posterior ophthalmomyiasis
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© 2006 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 9, 259–264