First Case of Heterochthonous Subconjunctival Dirofilariasis Described in Poland

A 55-year-old Polish male presented with discomfort, redness, itching, and swelling in the left eye that had begun three days before seeking medical help. Slit-lamp examination revealed an actively moving subconjunctival worm located inferotemporally ( Figure 1 ). A complete, live, moving nematode was removed under local anesthesia, and it was first stored in physiological saline for microscopic examination and then, put into 70% alcohol with glycerin and submitted for parasitological identification. The diagnosis was based on the following morphological features of the parasite: body length = 85.1 mm; maximum body width = 0.545 mm; esophagus = 0.895 mm long; vulva a little behind the esophagus; tail = 0.10 mm long, almost terminal; and cuticle with longitudinal combs on the surface ( Figure 2 ). The worm was identified as an immature female nematode of the species Dirofilaria repens ( Onchocercidae ). The patient’s blood tests were within the normal limits. Neither eosinophilia nor microfilaremia were detected. The infection with ocular dirofilariasis probably occurred during a visit to Greece 8 months before the symptoms occurred. 1 However, because of recent reports of new endemic areas of dirofilariasis in countries conterminous to Poland, an autochthonic infection cannot be excluded. 2 The differential diagnosis of subconjunctival filariasis should include loaiasis.