
衛生署豐原醫院日前有一位六十歲婦女因為眼睛發紅、有異物感且分泌物增加,經眼科主任楊逸儒檢查發現,她是罹患在台灣罕見的「東方眼蟲症」,即眼睛有三條像細小「吻仔魚」的寄生蟲,取出後才解除眼睛的不適。
楊逸儒檢查這位婦人雙眼視力正常,不過卻在右眼發現三條約一公分,白色纖細的蟲體,經鑑定是「結膜吸吮線蟲」,一一取出三條蟲後,症狀隨即改善。
楊逸儒指出,結膜吸吮線蟲原本是寄生在貓、狗的眼部,但這位婦人家中並無養狗,仔細尋問下,可能是鄰居有養狗,經由蒼蠅攜帶幼蟲而使人的眼睛意外受到感染。
因為蟲在眼部活動時,會造成眼部的刺激及損傷,加上蟲體的分泌物及排泄物的刺激,病人眼睛會有異物感、眼睛發紅等過敏症狀,如果蟲鑽入眼球內部,則會造成青光眼、白內障、虹彩炎等併發症而影響視力。
楊逸儒說,這種因結膜吸吮線蟲寄生眼睛,造成眼睛不適的症狀,主要出現在亞洲地區,如俄羅斯、中國、韓國、東南亞等,因此稱為「東方眼蟲症」,但在台灣極為罕見。
治療的方法除了將寄生蟲逐一抓除外,為避免還有蟲卵寄生,需每二週定期回眼科門診,並持續追半年。他並且提醒民眾,養貓狗寵物要注意清潔衛生,住家環境要打掃乾淨。
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愛生食、吃野味、衛生習慣不良者,小心眼球內有蟲。高醫眼科門診病患中,發現眼球內有一隻長一公分的結膜吸吮線蟲,幸好及時發現取出,否則造成寄生蟲性眼內炎,嚴重時會造成失明。
高醫眼科主治醫師賴昱宏表示,患者為五十多歲,造船廠的技工,平日喜歡吃田鼠肉、吃蝸牛、生魚片,且衛生習慣不好。
患者因神經方面的症狀求診,在核磁共震檢查時發現腦有空洞,是寄生蟲造成的,脊椎液檢查,有廣東住血線蟲、且糞便中有中華肝吸蟲,因眼睛紅腫疼痛轉往眼科求診,在檢查過程發現眼球瞳孔前的眼前房水樣液中,有一隻長一公分的結膜吸吮線蟲游來游去,最後用鑷子取出。
賴昱宏指出,結膜吸吮線蟲的媒介是蒼蠅,會進入眼球內,可能是蟲體順著血液到眼球血管末梢鑽進去,或是從眼結膜鑽進去都有可能。結膜吸吮線蟲會引起嚴重發炎,破壞眼睛組織,影響視力,甚至造成失明。
眼睛內有蟲,不只是結膜吸吮線蟲,還有經由中間宿主蝸牛、水蛭、淡水蝦等感染的廣東住血線蟲。高醫在七十六年間即在中華民國眼科醫學會刊中發表一名十四個月大的女嬰,患有嗜伊紅性腦膜炎,併有左眼前房蟲體寄生,導致眼內炎及脈絡網膜炎,經三個月的治療才改善症狀。經追查女嬰居住環境有接觸「薄殼蝸牛」的可能,蝸牛體內也有廣東住血線蟲。賴昱宏表示,避免寄生蟲感染,最好養成勤洗手的衛生習慣,萬一眼睛癢想要揉搓眼睛前,務必洗手。在飲食上,最好熟食,砧板要生食、熟食分開使用,避免污染而生病。喜歡吃野味的民眾更要注意衛生,以免病從口入。
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Thelazia callipaeda
Common name. Oriental eyeworm
Disease. thelaziasis
Geographic distribution. India, Burma, China, Korea, Japan, Russia, etc.
Infection rate. Thelaziasis is thought to be sporadically occurring throughout the world.
Life cycle. The adult worm is parasitic in the conjunctival sac of a final host, and it liberates viviparous larvae. These larvae are equivalent to the 1st stage larva. When they are swallowed by fly, They take off the sheaths in the digestive tract, go through the wall, invade the ovary or testis, where They become thin, 2-2.5 mm long 3rd stage larvae after two molts. They are the infective larvae. When the fly lick tears in the eyes of a final host, the larvae enter the conjunctival sac, and become adults in a month after two molts. The final hosts are mainly dogs and cats, and occasionally rabbits, monkeys, foxes, and humans. The intermediate hosts are insects. In Japan, species of Genus Amiota have been identified.
Morphology. The adult is thin and long. The female is about 15 mm long with thin both ends. The male is about 10 mm long, with a curled tail. In female, the vagina opens at the vulva located little behind the center of the esophagus on the ventral side.
Pathology and clinical symptoms. In case of human infection, it is generally noticed by severe foreign body sensation in early stage. In dogs and cats, however, chronic conjucntivitis induces photophobia, corneal opacity, or ulcer of the cornea.
Diagnosis & Treatment. Detection and removal of the worm.


