Authors: Amit Mishra, Harald Gjerde, Tim Mailman, Curtis Archibald

Author Disclosure Block: A. Mishra: None. H. Gjerde: None. T. Mailman: None. C. Archibald: None.

Abstract Body:

Purpose: Palpebral myiasis is a rare cause of persistent eyelid swelling. In the literature myiasis has been shown to lead to significant morbidity in certain cases. We present a case of palpebral myiasis in a pediatric patient with recent travel to Central America.
Study Design: Case Report.
Methods: Patient's clinical and surgical charts were reviewed. This included pertinent history, exams, investigations, and procedures. Review of the literature was also performed.
Results: A 15 year old male with recent travel to Costa Rica presented with a 2-week history of left upper eyelid swelling. Oral and subsequent intravenous antibiotics were initiated for preseptal cellulitis. On examination, the patient had a swollen, firm, erythematous left upper eyelid with a small pore on the skin and minimal purulence. CT scan was in keeping with preseptal cellulitis. Despite antibiotic treatment, the patient's symptoms did not improve, necessitating an incision and drainage (I&D) for a suspected abscess. During the procedure, a small foreign organism was isolated from the upper eyelid. The organism was determined to be a bot fly (Dermatobia hominis) by the microbiology consultant. Post I&D of the eyelid, topical and oral antibiotics were continued, and the patient showed significant improvement. He was discharged home in stable condition. He had no evidence of permanent sequelae on follow up exam.
Conclusions: According to our literature review, this is a rare case of palpebral myiasis caused by Dermatobia hominis in North America. Dermatobia hominis is native to Central and South America, and is typically not seen in Canada. Myiasis should be included on the differential for a non-resolving eye lid edema, with higher suspicion in those with a recent travel history to endemic regions. Prompt diagnosis would allow for limitation of morbidity related to the bot fly larvae.