*3.2.3 Clinical peculiarities*

Ocular larva migrans is mainly unilateral eye involvement but may appear bilateral [52]. One exclusive feature in ocular larva migrans might be present as migrating granuloma, either continuous or discontinuous. The clinical presentations can be categorized as.


Vision loss might occur as result to severe intraocular inflammation and consecutive vitritis, aggravation of underlying comorbidities and caused by the location of the granuloma itself.

### *3.2.4 Diagnostics*

Diagnosis can be determined by evaluation of clinical characteristics assessed by basic ophthalmologic methods and supported by imaging via ultrasound and the detection of the typical granuloma in the course. And additionally performed serological tests to detect Toxocara larvae specific serum antibodies via indirect enzymelinked immunosorbent assay [50, 54, 55]. Titers higher than 1:32 in ELISA indicate

toxocariasis with sensitivity of 78% [57]. In contrast, titers lower than 1:8 cannot completely rule out toxocariasis infection in the presence of typical clinical signs. Total IgE serum levels might support diagnosis and can be beneficial in monitoring treatment efficacy when decreasing under therapy [48, 49]. Eosinophilia as seen in visceral larva migrans is usually not present in ocular larva migrans.

#### *3.2.5 Therapy*

Standard treatment of active intraocular inflammation is the application of systemic and topic corticosteroids to reduce inflammation, limiting membrane formation and vitreous opacity, and improving vision [48, 49, 53, 58**–**60]. Antihelminthic treatment with albendazole or diethylcarbamazine in ocular larva migrans is controversially discussed due to lack of knowledge about intraocular efficacy. The combination with albendazole and corticosteroids shows effects with regard to reduction of recurrence [48, 49, 59] compared with corticosteroid-only treatments. Vitreoretinal surgical interventions might improve vision, if structural problems such as vitreous opacity, retinal detachment, or epiretinal membranes persist after medical therapy [48, 49, 61].
