Thelazia callipaeda infestation with tarsal ectropion

Purpose: To report a case of Thelazia callipaeda infestation with tarsal ectropion. Case summary: A 79-year-old man presented with epiphora and a sensation of a foreign body in his right eye that had persisted for several months. On the initial examination, he had conjunctival injection, conjunctival follicles, telangiectasia of the lid margins, meibomian gland dysfunction, and tarsal ectropion. We performed a lateral tarsal strip operation to treat the tarsal ectropion. During surgery, we identified and removed four parasites (about 1-2 cm in length and 0.5 mm in width) that had not been apparent on slit lamp examination. The parasites were identified as Thelazia callipaeda. The patient's symptoms subsequently improved considerably; he has followed up to the present time without recurrence. Conclusions: In the presence of continuous extraocular inflammation, as with infestation by Thelazia callipaeda, ectropion can be induced by several possible causes. Involutional ectropion can be accelerated mechanically through rubbing. Other causes include inferior force from inflammation of the connective tissue and temporary blepharospasm.