A Rare Case of Asymptomatic External Ophthalmomyiasis Manifesting with Corneal Ulcer

Introduction: To report a rare case of asymptomatic external ophthalmomyiasis manifesting with chronic corneal ulcer.   Case: A 65-year-old diabetic female, residing in a rural area, was admitted to Khatam-al-Anbia Eye Hospital for diabetic retinopathy evaluation. The patient had no ocular surface complaints. On examination, her best-corrected visual acuity was counting fingers in the right eye and 4/20 in the left eye. A chronic corneal ulcer (similar to ocular herpes) was accidentally diagnosed in the superior cornea with three dead larvae in the superior tarsal conjunctiva. High-power magnified biomicroscopic examination did not indicate any intraocular infestation. Fundus examination revealed severe non-proliferative diabetic retinopathy and clinically significant macular edema in both eyes. After removing the dead larvae, the ulcer improved within one week by topical antibiotics and frequent use of lubricant. The patient did not experience any relapse during the three-month follow-up. Conclusion: Ophthalmomyiasis can be a differential diagnosis for corneal ulcers. Therefore, this rare asymptomatic case must be considered in immunocompromised patients, particularly in rural areas.