Trematode induced ocular granuloma in children from South India

BACKGROUND: Over the past few decades, children from the south eastern regions of India presented with anterior chamber angle granulomas and/or subconjunctival granulomas or a retro corneal membrane with nodules at the advancing edge. These lesions were initially considered as tuberculous in origin and were referred as "conglomerate tubercles" for several years. Subsequent investigations identified the true etiology as trematode eye disease. PURPOSE: To analyze the epidemiological, geographical, and clinical characteristics of pediatric patients diagnosed with ocular granuloma caused by trematode infection. METHODS: A retrospective review was conducted on medical records of pediatric patients with the diagnosis of anterior chamber granuloma or subconjunctival granuloma seen between 1997 and 2017. Data were compiled and analyzed descriptively. RESULTS: A total of 269 children were diagnosed with trematode granuloma. Among them, 216 were boys and 53 were girls, with the age ranging from 3 to 16 years and a mean age of 10.13 years ± (3.01) years. The majority of cases were reported from Tamil Nadu. Of 269 children, 171 received medical treatment, and 98 children underwent surgical removal of the granuloma. Visual prognosis was generally favorable, when the visual axis was spared. CONCLUSION: Trematode-induced ocular granuloma is a distinct parasitic condition predominantly affecting children in specific geographical areas, especially in those living near trematode larva contaminated water bodies. Accurate identification of the etiology is essential to ensure effective management and to prevent vision loss.