Hiding in plain sight: A rare case of ocular thelaziasis

A 65-year-old male patient presented to eye outpatient department of a zonal hospital in North Eastern India with complaints of diminution of vision for 1-year duration. On ocular examination, his unaided visual acuity was 6/36 right eye and 6/12 left eye. He was diagnosed as a case of immature senile cataract with nuclear sclerosis grade 2+ in the right eye and immature senile cataract with nuclear sclerosis grade 1+ in the left eye, with no other ocular or systemic findings. He was taken up for phacoemulsification cataract surgery in the right eye. He underwent uneventful phacoemulsification with posterior chamber intraocular lens implantation in the right eye. On completion of cataract surgery, while removing the wire speculum, a slender, motile, chalky white worm was noticed in the lower fornix. The worm was retrieved and was sent for microbiology examination. The patient was given a thorough antibiotic wash of cul-de-sac of conjunctiva. The eye was patched with antibiotic ointment. The worm was identified as a female Thelazia callipaeda. This condition is rare and may present asymptomatically as in our case or may be a cause of ocular morbidity leading to intraocular as well as extraocular manifestations.