Sir,

Myiasis is a parasitic infestation caused by dipterous fly larvae of several species including the sheep bot fly, *Oestrus ovis*, and the preferred intermediate host is typically sheep and goats, but occasionally this organism infests humans. The first stage larvae are obligate parasites that burrow their way into the host tissues.\[[@ref1]\] The host disease state is referred to as ophthalmomyiasis when the larvae are found on or within the ocular tissues.

We report a case of an 83-year-old man who presented with a painful ulcer over the lateral aspect of the left eye since a year. It was accompanied with itching and oozing from the same eye, which was of less than one-week duration. This was associated with swelling and inability to open the left eye. The patient had been on treatment for hypertension and diabetes irregularly. Vital parameters and systemic examination were within normal limits. Local examination showed edema of the left eyelid. There was tenderness with an ulcer measuring 5 cm × 6 cm having undermined edges and bone deep slough. \[[Figure 1](#F1){ref-type="fig"}\] Multiple maggots were seen in the ulcer. Left eye examination showed maggots, seropurulent discharge. The conjunctiva showed chemosis in inferior conjunctiva, visual acuity was 6/24; orbital margins could not be assessed due to tense lid edema. Cornea, anterior chamber, pupils, lens were normal. Ear, nose, throat were normal.

![Ulcer over the lateral aspect of the left eye](IJD-59-308-g001){#F1}

Lab abnormalities were: Total leukocyte count was 12000/mm;\[[@ref2]\] Blood sugar level (Post-prandial) was 133 mg%. Other investigations were within normal limits. A 4 mm punch biopsy taken from the lesion was suggestive of basal cell carcinoma \[[Figure 2](#F2){ref-type="fig"}\]. A CT scan showed inflammatory changes in extra canal compartment of the left orbit, subtle erosions of the left orbital wall.

![HPE showing basal cell carcinoma (H and E, ×10)](IJD-59-308-g002){#F2}

Maggots were removed manually from the ulcer \[[Figure 3](#F3){ref-type="fig"}\] after immobilizing them by applying 4% lignocaine lotion. Turpentine oil painting was done to remove them from deeper tissues. Injection ceftriaxone 1 gram was given intravenously, 12 hourly. Injection metronidazole was given 8 hourly. Moxifloxacin eye drops were added.

![Maggots being removed from the ulcer](IJD-59-308-g003){#F3}

Myiasis commonly affects skin ulcers. Eyes, nose, nasal sinuses, urogenital tract are less commonly affected.\[[@ref2][@ref3][@ref4]\] Ocular involvement occurs in about \< 5% of all cases of human myiasis.\[[@ref5]\] Ophthalmomyiasis is classified as ophthalmomyiasis externa if the larvae are present on the lids, conjunctiva, and Ophthalmomyiasis interna when there is intraocular penetration of larvae.\[[@ref5]\]
