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A healthy 43-year-old Nigerian man living in the United States noticed something wiggling in his right eye while he was driving. He went to his optometrist, who saw an opaque, thin, undulating worm under the conjunctiva. Attempts to extract the worm were unsuccessful. The irritation and discomfort in the patient's eye abated after one day, and he did not notice the presence of the worm or its movement again until one week later. By the time the patient visited an ophthalmologist, the worm could not be seen. Four days later, the worm wiggled again and was directly observed (arrow, Panel A) and successfully extracted (Panels B and C). The patient's last visit to Nigeria had been nine years previously. He reported no history of skin swellings or other symptoms. The peripheral eosinophil count and serum IgE levels were normal, and a blood smear for microfilaria was negative. The serum antifilarial antibody level was elevated, at 245.6 µg per milliliter; the morphologic features of the worm were most consistent with the Loa loa species (Panel D). The patient did not return for treatment with diethylcarbamazine.
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