DOI: 10.1097/iop.0000000000003305 ISSN: 0740-9303

Parasitic Infections of the Lacrimal System: A Major Review of Etiology, Clinical Presentation, and Management

Yasaman Salari, Valerie Juniat, Mohammad Javed Ali
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Purpose:

Parasitic infections of the lacrimal system are rare and often under-recognized causes of lacrimal pathology. Their clinical presentation frequently mimics more common conditions such as chronic dacryocystitis, leading to diagnostic challenges and delays in appropriate management. This study aims to systematically review the literature on parasitic infections of the lacrimal system and to characterize their etiology, clinical presentation, diagnostic approaches, management strategies, and outcomes.

Methods:

A systematic review was conducted across MEDLINE, Embase, Emcare, and PubMed from inception to March 2026. Studies reporting parasitic infections involving the lacrimal apparatus were included. Data on demographics, clinical presentation, anatomical involvement, causative organisms, diagnostic methods, treatment, and outcomes were extracted. Due to heterogeneity and predominance of case reports and small series, a qualitative descriptive analysis was performed.

Results:

A total of 44 studies comprising 172 cases were included. Rhinosporidium seeberi was the most frequently reported pathogen, accounting for 147 cases (85.5%), followed by Leishmania (8 cases, 4.7%) and Ascaris lumbricoides (7 cases, 4.1%). The lacrimal sac was the most commonly involved site. Clinical presentation was nonspecific, with epiphora and medial canthal swelling predominating. Diagnosis was most often established by histopathology following surgical intervention. Management varied by etiology, with surgical excision commonly used for rhinosporidiosis and mechanical extraction for helminthic infections. Outcomes were generally favorable, although recurrence was reported, particularly in R. seeberi infections.

Conclusions:

Parasitic infections of the lacrimal system are rare but clinically important, with diverse presentations and management approaches. Increased awareness is essential for early diagnosis and appropriate treatment. Further studies with standardized reporting are needed to optimize management strategies.

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