Orbital Cysticercosis: Clinical Manifestations,Diagnosis, Management, and OutcomeSuryasnata 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, FRCS1

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 ocularmotility restriction (64.3%), proptosis (44.4%), and diplopia (36.8%). The cyst locations in the decreasingorder of frequency were anterior orbit (69%), subconjunctival space (24.6%), posterior orbit (5.8%), and theeyelid (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 166patients. Although 149 patients received a combination of oral albendazole and prednisolone, 1 patientreceived oral albendazole alone, 7 patients received oral prednisolone alone, and 1 patient received oralpraziquantel. 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 in29 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 ofthe above in 9 patients.

Conclusions: Orbital cysticercosis is a common clinical condition in the developing world. It typically affectsyoung individuals and has a wide spectrum of clinical manifestations. Both B-scan ultrasonography andcomputed tomography scan are useful in confirming the diagnosis. Despite resolution of cysticercosis withmedical 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 discussedin this article. Ophthalmology 2010;117:600–605 © 2010 by the American Academy of Ophthalmology.

Cysticercosis is a parasitic infestation by Cysticercuscellulosae, which is the larval form of Taenia solium. Itis endemic in regions with poor sanitation. Human infec-tion occurs by drinking contaminated water, eating un-cooked vegetables infested with eggs of the worm, andautoinfection.1,2 The most common form of systemicinvolvement is neurocysticercosis.1 Ocular and adnexalcysticercosis represents 13% to 46% of systemic dis-ease.3 An earlier publication from India had reportedocular 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 Increasedavailability of imaging techniques has helped detect or-bital cysticercosis in the recent times.5 This large caseseries describes the clinical manifestations, management,and outcome of orbital cysticercosis in a tertiary eye care

center in Southern India.

600 © 2010 by the American Academy of OphthalmologyPublished by Elsevier Inc.

Patients and Methods

A retrospective chart review was carried out of all consecutivepatients with orbital cysticercosis presenting between March 1990and December 2001. Orbital cysticercosis was diagnosed whenany of the following was present: cyst with a scolex on imaging(B-scan ultrasonography or computed tomography scan), cysticlesion without a scolex on imaging with therapeutic response toanticysticercal therapy, or histopathologic examination of the ex-cised cyst showed cysticercosis.

Data collected included age, gender, laterality, predominantsymptoms and signs at presentation, referral diagnosis, prior treat-ment, and response to such treatment. Clinical examination detailsincluded presence and degree of proptosis, strabismus, motilitylimitation, diplopia, ptosis, and periocular swelling and eyelidedema. Clinical and differential diagnoses, serology, and results ofimaging (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

ISSN 0161-6420/10/$–see front matterdoi:10.1016/j.ophtha.2009.07.030

, the

Rath et al � Orbital Cysticercosis

prednisolone 1 mg/kg body weight tapered over 4 to 6 weeks. Thedose and duration of oral albendazole and oral prednisolone werenoted, and indications for and details of surgery were recorded.The response to therapy and the presence of residual deficit at thefinal follow-up visit were documented in detail.

The main outcome measures were clinical resolution and sig-nificant residual deficit. Clinical resolution was defined as com-plete resolution of clinical signs, spontaneous extrusion of the cyst,or contact B-scan ultrasonography or computed tomography scanshowing resolution of the cyst in cases where residual deficitspersisted (Fig 1). Significant residual deficit was defined as prop-tosis �2 mm, ptosis �2 mm, ocular motility restriction � �1 ona scale of 0 to �5 (0 for full excursion and �5 for failure to reachthe midline, �4 reaching midline, �3 to �1 for excursions in 25%increments), diplopia in primary position and reading position, andstrabismus �10 prism diopters.

Results

A total of 216 patients of ocular cysticercosis were diagnosedduring the study period (March 1990 to December 2001). Forty-five patients (20.8%) had intraocular cysticercosis. The remaining171 patients (79.2%) who had orbital cysticercosis were includedin this study. The median age at presentation was 13 years (range2–65 years), and 93 (54.4%) were male. All patients had unilateralinvolvement. The right eye was involved in 94 patients (55.0%).

Only 12 patients (7.0%) were referred with the diagnosis ofcysticercosis. Treatment before referral in 46 patients (29.9%)included oral steroids (31/171, 18.1%), topical steroids (9/171,5.3%), combination of oral albendazole and steroids (4/171, 2.3%),

Figure 1. Cysticercosis in the medial rectus muscle. A, B-scan ultrasonograafter treatment with a combination of oral albendazole and prednisolone

Figure 2. Subconjunctival cysticercosis. A, Subconjunctival cyst in an 8-year-

and systemic antibiotics (2/171, 1.2%). A total of 125 patients(73.1%) had not received any prior treatment.

The main symptom at presentation was periocular swelling in65 patients (38.0%), followed by proptosis in 41 patients (24.0%),ptosis in 24 patients (14%), pain in 17 patients (9.9%), diplopia in14 patients (8.2%), restriction of ocular motility in 5 patients(2.9%), squint in 4 patients (2.3%), and decreased vision in 1patient (0.6%). The median duration of symptoms was 2 months(range 0–24 months).

The clinical signs overlapped, with more than 1 clinical signseen in 140 patients (81.9%) (Table 1, available at http://aaojournal.org). Overall, 76 patients (44.4%) had proptosis at presentation; ofthese, 40 (52.6%) had axial proptosis and 36 (47.4%) had nonaxialproptosis. In those with nonaxial proptosis, inferior displacementof the eye was seen in 26 patients (72.2%), whereas superior andtemporal displacements were seen in 5 patients (13.9%) each.Hertel’s exophthalmometry measured proptosis of �4 mm in 51patients (67.1%) and �4 mm in 17 patients (22.4%) and was notdocumented in 8 patients (10.5%). Strabismus was seen in 39patients (22.8%), and the types overlapped: hypotropia in 21patients (53.8%), exotropia in 18 patients (46.2%), hypertropia in6 patients (15.4%), and esotropia in 4 patients (10.3%). Restrictionof ocular motility was seen in 110 patients (64.3%). Supraductionwas limited in 45 patients (40.9%), abduction in 16 patients(14.5%), adduction in 11 patients (10.0%), infraduction in 9 pa-tients (8.2%), and a combination of the above in 29 patients(26.4%). Diplopia was seen in 63 patients (36.8%) at presentation.Ptosis and eyelid edema were seen in 49 patients (28.7%) and 30patients (17.5%), respectively. Eight patients (4.7%) presentedwith orbital cellulitis. Visual acuity at presentation was �20/40 in157 patients (91.8%), between 20/40 and 20/100 in 6 patients

howing a well-defined cyst within the medial rectus muscle. B, Four weekscyst has resolved but mild muscle thickening persists.

phy s

old child. B, Resolution after spontaneous extrusion.

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(3.5%), and worse than 20/100 in 2 patients (1.2%); visual acuityrecord was not available in 6 patients (3.5%).

Cyst location was anterior orbit in 118 patients (69.0%), subcon-junctival space in 42 patients (24.6%) (Fig 2), posterior orbit in 10patients (5.8%), and eyelid in 1 patient (0.6%). All the 128 orbitalcysts were either located within extraocular muscles or attached to it.In addition, 10 cysts in subconjunctival location were attached to oneof the extraocular muscles. In all, 138 of 171 patients (80.7%) hadcysts in relation to an extraocular muscle. The frequency of involve-ment of extraocular muscles is as follows: superior rectus in 46patients (33.3%), inferior rectus in 32 patients (23.2%), medial rectusin 22 patients (15.9%), lateral rectus in 22 patients (15.9%), superioroblique in 11 patients (8.0%), and levator palpebrae superioris in 5patients (3.6%). Contact B-scan ultrasonography was performed in135 patients (78.9%) and was diagnostic of cysticercosis in 114patients (84.4%). It showed a cyst with a scolex in 106 patients(78.5%) and a cyst within an extraocular muscle but without a scolexin 8 patients (5.9%).

Computed tomography scan was performed in 79 patients(46.2%). The results demonstrated a scolex in 39 patients (49.4%) andhelped diagnose neurocysticercosis in 3 patients. Sixty-six patients

Figure 3. Subconjunctival cysticercosis with dacryoadenitis. A, A 12-ye1-week duration simulating dacryoadenitis. B, There was a temporal subcogland is evident. D, Complete resolution at 6 weeks after treatment with

Figure 4. Cysticercosis in the medial rectus muscle with orbital inflammapain in the right eye of 3 days duration. B, Computed tomography scan sho

C, Complete resolution was achieved at 4 weeks after treatment with a combi

602

who had undergone both B-scan ultrasonography and computed to-mography scan and had good-quality images available in the fileswere specifically reviewed for clarity of delineation of the cyst andvisualization of the scolex. Of these, B-scan ultrasonography wasmore informative in 31 patients (47.0%), computed tomography wasmore informative in 17 patients (25.8%), and both the modalities wereequally informative in 18 patients (27.3%). Serology for anticystic-ercal antibody was positive in 10 of 29 patients (34.4%).

Of 171 patients, 166 were treated and 5 did not return fortreatment. Orbital cysticercosis was predominantly managed (158/166, 95.2%) by medical treatment. A combination of oral albenda-zole (15 mg/kg body weight/day for 4 weeks) and prednisolone (1mg/kg body weight/day, tapered over 4–6 weeks) was used in 149of 158 patients (94.3%). The remaining patients were treated withoral prednisolone alone (7/158, 4.4%), albendazole alone (1/158,0.6%), or oral praziquantel (40 mg/kg body weight for 4 weeks)(1/158, 0.6%). Eight patients who did not receive primary medicaltherapy included 4 (2.4%) with primary spontaneous extrusion ofthe subconjunctival cyst before the treatment was instituted (thesepatients were treated with tapering dose of topical betamethasone0.1% over 3-4 weeks for control of local inflammation) and 4

child presenting with left eyelid edema, mechanical ptosis, and pain oftival cyst. C, Spillover inflammation of the palpebral lobe of the lacrimal

mbination of oral albendazole and prednisolone.

A, A 6-year-old child presented with acute periocular inflammation andcyst with central scolex in close relationship to the medial rectus muscle.

ar-oldnjunc

tion.wed a

nation of oral albendazole and prednisolone.

Rath et al � Orbital Cysticercosis

(2.4%) who underwent primary surgical excision. In all, surgicalexcision was performed in 8 patients (4.8%), including primarysurgery in 4 patients and failure of medical therapy in 4 patients.

Of 166 patients who received treatment, 28 were lost to follow-up. The overall median follow-up in 138 patients who completedtreatment and returned for follow-up was 4 months (mean,11.1�18.9 months; range, 1–108 months). Among these 138 pa-tients, clinical resolution of orbital cysticercosis was seen in 128patients (92.8%) (Figs 3–6) and nonresolution in 10 patients(7.2%) at 1 month after initiation of treatment. Of 85 patients whohad follow-up of more than 3 months after initiation of treatment,81 (95.3%) showed clinical resolution of orbital cysticercosis.

Spontaneous extrusion of the cysticercus cyst was documentedin 12 patients (7.0%) at a median duration of 10 (range 0-135) daysafter initial clinical presentation (Fig 2). In this subgroup, thelocation of the cyst was found to be subconjunctival in 7 patientsand anterior orbital in 5 patients. Five patients with spontaneousextrusion had received primary medical treatment with a combi-nation of oral albendazole and prednisolone; 4 patients had notreceived any treatment; and 3 patients had received only oralprednisolone.

Significant residual deficit was present in 29 of 138 patients(21.0%) at the final follow-up and included proptosis in 7 (5.1%),ptosis in 6 (4.3%), ocular motility restriction in 3 (2.2%), diplopiain 2 (1.4%), strabismus in 2 (1.4%), and a combination of 1 ormore of the above in 9 (6.5%).

Discussion

We report a large series of patients of orbital cysticercosisseen over a decade at a tertiary eye care center in Southern

Figure 5. Cysticercosis in the inferior rectus muscle with restricted oculaHer ocular motility was restricted in supraduction in the right eye. B, Coinferior rectus muscle. C, The ocular motility recovered, and the childalbendazole and prednisolone.

Figure 6. Cysticercosis in the levator palpebrae superioris muscle manifesthe left upper eyelid of 4 weeks duration. Cysticercosis was diagnosed on B

The child recovered from ptosis at 4 weeks after treatment with a combination

India. This report aimed to describe the clinical manifesta-tions, diagnosis, management, and outcome of orbital cys-ticercosis. On the basis of our experience, certain aspectsneed to be highlighted.

Only 12 patients (7%) had been referred with a diagnosis ofcysticercosis. This may indicate a lack of awareness amongophthalmologists about the various manifestations of cysticer-cosis, even in endemic regions. Several reports of ocular cys-ticercosis have been published in the literature. The moststriking difference is in the primary site of involvement; in-traocular cysticercosis is predominant in the Western countries,whereas extraocular is more common in the Indian population(Table 2).1,2,4–27 Several authors have attributed geographicand environmental factors to this difference.8,9 Reports fromIndia list subconjunctival cysticercosis (44%–86%) as themost common type (Table 2). In our series, orbital location wasthe most common. An earlier study showed that the subcon-junctival cyst adheres to the insertion site of extraocular mus-cles and therefore may represent a type of myocysticercosis.9

Madigubba et al8 published a large series of 118 cases ofocular cysticercosis in 2007. Their series constituted patientswho underwent surgery between 1981 and 2000 in SouthernIndia. In this study, the authors have observed a trend showinga shift in localization from subconjunctival space to intraocularcysticercosis over the 2 decades. Our series does not supportthis observation.

In our series, 64.3% of patients had restriction of ocularmotility at presentation, 44.4% of patients had proptosis,36.8% of patients had diplopia, 28.7% of patients had pto-sis, 22.8% of patients manifested strabismus, 17.5% of

ement. A, A 15-year-old girl reported double vision of 3 weeks duration.ed tomography scan showed a well-defined cyst with a scolex within thefree of diplopia at 4 weeks after treatment with a combination of oral

ith ptosis. A, A 14-year-old child was referred with acute onset ptosis ofultrasonography and was localized to the levator palpebrae superioris. B,

r movmputwas

ting w-scan

of oral albendazole and prednisolone.

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Ophthalmology Volume 117, Number 3, March 2010

patients had eyelid edema, and 4.7% of patients presentedwith orbital cellulitis.

Spontaneous extrusion of cysticercosis is rare, as evi-denced by a few anecdotal reports. In our series, 12 patientshad spontaneous extrusion, 7 of whom had not received oralalbendazole. Earlier reports have speculated about the roleof albendazole in hastening spontaneous extrusion of cyst.17

The factors predictive of spontaneous extrusion of cystic-ercosis remain uncertain.

Medical management resulted in clinical resolution oforbital cysticercosis in 92.8% of patients at 1 month afterinitiation of treatment and in 95.3% of patients at 3months in our series. However, 21% of our patientsshowed significant residual deficits at the final follow-up.These included proptosis, ptosis, ocular motility restric-tion, diplopia, strabismus, or a combination of the above.We believe early diagnosis and treatment of orbital cys-ticercosis may limit eventual fibrosis of the extraocularmuscles and minimize residual deficits.

In conclusion, orbital cysticercosis is a common entity inSouthern India and typically affects young individuals. Ithas myriad clinical presentations depending on the site oflodgment. An increased awareness of the typical and atyp-ical presentations of orbital cysticercosis, coupled with ahigh index of clinical suspicion, may help in early diagno-sis. Medical management in orbital cysticercosis is ex-tremely effective and achieves clinical resolution in mostpatients. Despite clinical resolution, a significant number ofpatients have residual deficits.

References

1. Grover AK, Puri P. Orbital myocysticercosis presenting assubconjunctival abscess. Ind J Ophthalmol 1996;44:229–31.

2. Sihota R, Honavar SG. Oral albendazole in the management ofextraocular cysticercosis. Br J Ophthalmol 1994;78:621–3.

3. Mais FA. Cryosurgery in ocular cysticercosis [in Portuguese].

Table 2. Location of Ocular Cysticercosi

First Author, Year NSubconjunc

Space

Reports from Western CountriesGraefe, 18668 90 5 (6%Vosgien, 19118 266 84 (32Laingneer, 19328 35 7 (20Lech, 194915 115 7 (6%Welsh, 198726 13 1 (8%Wittig, 200127 71 2 (3%

Reports from IndiaReddy, 196421 10 6/10 (60Sen, 196722 11 9/11 (82Malik, 19684 14 10/14 (72Rao, 197223 15 13/15 (86Reddy, 198024 15 13/15 (86Kumar, 199512 33 1/33 (3%David, 200019 25 11/25 (44Chowdhary, 200320 18 14/18 (78Madigubba, 20078 118 74/118 (63Rath, 2009 216 42/216 (19

Rev Bras Ophthalmol 1969;28:99–106.

604

4. Malik SK, Gupta AK, Choudhry S. Ocular cysticercosis. Am JOphthalmol 1968;66:1168–71.

5. Sekhar GC, Honavar SG. Myocysticercosis: experience withimaging and therapy. Ophthalmology 1999;106:2336–40.

6. DiLoreto DA, Kennedy RA, Neigel JM, Rootman J. Infesta-tion of extraocular muscle by Cysticercus cellulosae. Br JOphthalmol 1990;71:751–2.

7. Sekhar GC, Lemke BN. Orbital cysticercosis. Ophthalmology1997;104:1599–604.

8. Madigubba S, Vishwanath K, Reddy G, Vemuganti GK.Changing trends in ocular cysticercosis over two decades: ananalysis of 118 surgically excised cysts. Indian J Med Micro-biol 2007;25:214–9.

9. Pushker N, Bajaj MS, Betharia M. Orbital and adnexal cys-ticercosis. Clin Experiment Ophthalmol 2002;30:322–33.

10. Bartholowmew RS. Subretinal cysticercosis. Am J Ophthal-mol 1975;79:670–3.

11. Kruger-Leite E, Jalkh AE, Quiroz H, Schepens CL. Intraocu-lar cysticercosis. Am J Ophthalmol 1985;99:252–7.

12. Kumar A, Kumar HT, Goyal M, et al. Socio-demographictrends in ocular cysticercosis. Acta Ophthalmol Scand 1995;73:438–41.

13. Menon V, Kumar G, Prakash P. Cysticercosis of extra-ocular muscles. J Pediatr Opthalmol Strabismus 1994;31:126–9.

14. Jena A, Sanchetee PC, Gupta RK, et al. Cysticercosis of thebrain shown by magnetic resonance imaging. Clin Radiol1988;39:542–6.

15. Lech Junior. Ocular cysticercosis. Am J Ophthalmol 1949;32:523–48.

16. Ursekar MA, Dastur DK, Manghiani DK, Ursekar AT. Iso-lated cysticercal infestation of extraocular muscles: CT andMR findings. AJNR Am J Neuroradiol 1998;19:109–13.

17. Bansal RK, Gupta A, Grewal SP, Mohan K. Spontaneousextrusion of cysticercosis: report of three cases. Indian JOphthalmol 1992;40:59–60.

18. Goodman KA, Ballagh SA, Carpio A. Case-control study ofseropositivity for cysticercosis in Cuenca, Ecuador. Am J TropMed Hyg 1999;60:70–4.

19. David S, Mathai E. Ocular cysticercosis—a review of 25

orted from Western Countries and India

Intraocular Orbit Eyelid

84 (93%) 1 (11%) 0182 (68%) 0 027 (77%) 1 (3%) 0

107 (93%) 1 (1%) 012 (92%) 0 064 (89%) 3 (4%) 1 (1%)

2/10 (20%) 1/10 (10%) 1/10 (10%)2/11 (18%) 0 01/14 (7%) 3/14 (21%) 01/15 (7%) 1/15 (7%) 0

0 0 2/15 (14%)26/33 (79%) 6/33 (18%) 06/25 (24%) 6/25 (25%) 2/25 (8%)

— — 2 (11%)31/118 (26%) 8/118 (7%) 5/118 (4%)45/216 (20%) 128/216 (59%) 1/216

s Rep

tival

)%)%))))

%)%)%)%)%))

%)%)%)

cases. J Assoc Physicians India 2000;48:704–7.

Rath et al � Orbital Cysticercosis

20. Chowdhary A, Bansal R, Singh K, Singh V. Ocular cysticercosis—aprofile. Trop Doct 2003;33:185–8.

21. Reddy PS, Satyendran OM. Ocular cysticercosis. Am J Oph-thalmol 1964;57:664–6.

22. Sen DK, Mathur RN, Thomas A. Ocular cysticercosis in India.Br J Ophthalmol 1967;51:630–2.

23. Rao N, Balakrishnan E. Cysticercosis of the eye. Orient Arch

Ophthalmol 1967;5:244–52.

Banjara Hills, Hyderabad, India.

24. Reddy CC, Gupta UP, Sarada P, et al. Ocular cysticercosis (astudy of 15 cases). Indian J Ophthalmol 1980;28:69–72.

25. Duke-Elder S, Perkins ES. System of Ophthalmology Vol 11.Diseases of Uveal Tract. CV Mosby: St Louis; 1966;478–88.

26. Welsh NH, Peters AL, Crewe-Brown W, et al. Ocular cystic-ercosis. A report of 13 cases. S Afr Med J 1987;71:719–22.

27. Wittig EO. Ocular cysticercosis—an epidemiological study.

Arq Neuropsiquiatr 2001;59:696–701.

Footnotes and Financial Disclosures

Originally received: November 5, 2008.Final revision: July 17, 2009.Accepted: July 23, 2009.Available online: January 8, 2010. Manuscript no. 2008-1313.1 Department of Ophthalmic Plastic Surgery, Orbit and Ocular Oncology,LV Prasad Eye Institute, Banjara Hills, Hyderabad, India.2 Department of Epidemiology and Biostatistics, LV Prasad Eye Institute,

Financial Disclosure(s):The author(s) have no proprietary or commercial interest in any materialsdiscussed in this article.

Supported by the Hyderabad Eye Research Foundation, Hyderabad, India.

Correspondence:Santosh G. Honavar, MD, FACS, Department of Ophthalmic Plastic Sur-gery, Orbit and Ocular Oncology, LV Prasad Eye Institute, LV Prasad

Marg, Banjara Hills, Hyderabad 500034, India. E-mail: honavar@lvpei.org.

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ELISA � enzyme-linked immunosorbent assay.

Ophthalmology Volume 117, Number 3, March 2010

Table 1. Orbital Cysticercosis: Clinical Manifestations,Diagnosis, Management, and Outcome in 171 Consecutive

Patients Presenting to a Tertiary Care Center in Southern India

Patient Demographics (n � 171)Median age at presentation, yrs (range) 13 (2–65)Male:female ratio 93:78Unilateral, n (%) 171 (100%)Referral diagnosis of cysticercosis, n (%) 12 (7%)

Symptoms at initial presentation (n � 171)Median duration of symptoms, mos

(range)2 (0–24)

Periocular swelling, n (%) 65 (38.0%)Proptosis, n (%) 41 (24.0%)Ptosis, n (%) 24 (14%)Pain, n (%) 17 (9.9%)Diplopia, n (%) 14 (8.2%)Restriction of ocular motility, n (%) 5 (2.9%)Squint, n (%) 4 (2.3%)Decreased vision, n (%) 1 (0.6%)

Clinical Signs at Initial Presentation (n �171)

Proptosis, n (%) 76 (44.4%)Motility restriction, n (%) 110 (64.3%)Diplopia, n (%) 63 (36.8%)Ptosis, n (%) 49 (28.7%)Eyelid edema, n (%) 30 (17.5%)Strabismus, n (%) 39 (22.8%)Orbital cellulitis, n (%) 8 (4.7%)

Location of the Cyst in the Orbit (n � 171)Anterior orbit, n (%) 118 (69.0%)Subconjunctival space, n (%) 42 (24.6%)Posterior orbit, n (%) 10 (5.8%)Eyelid, n (%) 1 (0.6%)

Location of the Cyst in Relation toExtraocular Muscle (n � 138)

Superior rectus, n (%) 46 (33.3%)Inferior rectus, n (%) 32 (23.2%)Medial rectus, n (%) 22 (15.9%)Lateral rectus, n (%) 22 (15.9%)Superior oblique, n (%) 11 (8.0%)Levator palpebrae superioris, n (%) 5 (3.6%)

Imaging (n � 171)B-scan ultrasonography, performed,

n (%)135 (78.9%)

B-scan ultrasonography, was diagnostic, n(%)

114 (84.4%)

B-scan ultrasonography, scolex identified,n (%)

106 (78.5%)

Computed tomography, performed,n (%)

79 (46.2%)

Computed tomography, scolex identified,n (%)

39 (49.4%)

Serology (n � 29)ELISA for anticysticercal antibodies was

positive10 (34.4%)

Management (n � 166)Primary medical management, n (%) 158 (95.2%)Oral albendazole � oral prednisolone,

n (%)149 (94.3%)

Oral prednisolone, n (%) 7 (4.4%)Oral albendazole, n (%) 1 (0.6%)Oral praziquantel, n (%) 1 (0.6%)Topical betamethasone after spontaneous

extrusion, n (%)4 (2.4%)

Surgical excision 4 (2.4%)Follow-up (n � 138)

Duration of follow-up in mos, median(mean � SD, range)

4 (11.1�18.9, 1–108)

(Continued)

605.e1

Table 1. (Continued.)

Outcome (n � 138)Complete clinical resolution, n (%) 128 (92.8%)Nonresolution, n (%) 10 (7.2%)No residual deficit 109 (79%)Significant residual deficit, n (%) 29 (21.0%)Residual proptosis, n (%) 7 (5.1%)Residual ptosis, n (%) 6 (4.3%)Residual ocular motility restriction,

n (%)3 (2.2%)

Residual diplopia, n (%) 2 (1.4%)Residual strabismus, n (%) 2 (1.4%)Combination of multiple residual deficits,

n (%)9 (6.5%)