Three cases of eosinophilic granulomatous conjunctivitis in the Netherlands

Purpose. To describe the occurrence of 3 cases of eosinophilic granulomatous conjunctivitis in the Netherlands, most likely caused by the infection with nematode larvae, also known as ocular habronemiasis. To the author’s knowledge ocular habronemiasis has not been documented previously in the Netherlands. Methods. Retrospective study. Case description based on data from the medical records of the equine hospital facility. Results. In the summer of 2015 two separate cases were presented at the equine hospital with complaints of a non-resolving conjunctivitis of the medial canthus. When reviewing the patient records, one other similar case was found which occurred in July 2001. The diagnosis was made on the basis of history, clinical signs including the presence of sulphur-like granules and histologic examination of biopsy specimens. In all three cases the histopathological examination yielded a severe chronic eosinophilic granulomatous conjunctivitis, which is consistent with the diagnosis of habronemiasis. Nematode larvae were seen in one of the biopsy specimens. In all three cases the treatment consisted of systemic ivermectin or moxidectin. Furthermore treatment combinations of surgical excision, topical levamisole solution, and triamcinolonacetonide sub-conjunctivally were used. Outcome. Treatment provided healing of the conjunctivitis in all three cases and there was no recurrence of the condition long-term. Conclusions. The results suggest that the diagnosis of ocular habronemiasis should be considered in the temperate oceanic climate of Western Europe when being presented with a horse with a granulomatous conjunctivitis, especially during the summer months. None.