Onchocerciasis (river blindness)

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    Ocular lesions result from the invasion of the eye by microfilariae. They generally develop in adults and progress to blindness in the absence of early treatment.

    Clinical features and treatment

    Ocular lesions are always associated with onchocercal skin lesions (see Onchocerciasis, Chapter 6).

    • Pruritus, hemeralopia (crepuscular blindness), decrease in visual acuity, narrowing of the visual field, awareness of microfilariae in the visual field (the patient sees “little wiggling worms before his eyes”).
    • Lesions of the cornea (punctuate, then sclerosing, keratitis), iris (iridocyclitis) or posterior segment (chorioretinopathy and optic atrophy); microfilariae within the anterior chamber or vitreous humor (slit lamp).


    For treatment, see Onchocerciasis, Chapter 6. Ivermectin treatment may improve anterior segment lesions (sclerosing keratitis, iridocyclitis) and visual acuity. Severe lesions (chorioretinal lesions, optic atrophy) continue to progress despite treatment.