Ocular Cysticercosis: Epidemiology, Diagnosis, and Management in the Era of Multimodal Imaging

Background: Ocular cysticercosis, caused by the larval stage of Taenia solium, is a significant but preventable cause of blindness in endemic regions. Prognosis is heavily dictated by the cyst’s anatomical location, the host’s inflammatory response, and the speed of clinical intervention. Despite its public health impact, diagnostic delays and varied clinical presentations persist. This narrative review synthesizes current evidence regarding the epidemiology, pathogenesis, and management of the disease. Methods: A comprehensive review was performed using peer-reviewed literature and clinical guidelines from the past 20 years. The study analyzed data across various manifestations, including intraocular, orbital, adnexal, and neuro-ophthalmic involvements, focusing on the interplay between immunopathogenesis and therapeutic outcomes. Results: Prevalence is highest in areas with poor sanitation and traditional pig husbandry. Intraocular cysts, particularly subretinal and intravitreal types, present the highest risk for irreversible vision loss due to secondary retinal detachment and severe vitreous inflammation. Diagnostic precision has significantly improved with high-resolution optical coherence tomography (OCT) and B-scan ultrasonography, which can visualize scolex morphology. However, neuroimaging remains a mandatory adjunct to rule out concurrent neurocysticercosis. Treatment must be highly individualized: surgical excision is preferred for intraocular cysts to prevent inflammatory toxic reactions, while medical therapy (anthelmintics) requires careful corticosteroid cover to mitigate inflammatory damage. Integrated "One Health" strategies, including porcine vaccination and mass drug administration, are effective but require broader implementation. Conclusion: Addressing ocular cysticercosis requires a multidisciplinary approach. Early detection via advanced imaging and coordinated public health interventions are vital for improving visual recovery and achieving long-term disease control.