Use local anesthesia to make small incision in conjunctiva to extract worm with forceps
First Line Treament
Only treatment that is definitively curative killing both larvae and adult worms
May need 2-3 courses of treatment
First course should last 3-4 weeks
Starting doses should be divided into BID or TID doses starting at 3-6mg/day and doubling daily until up to 400mg/day is reached
Side effects occur in >50% of people – pruritus, rashes, edema, headaches, fever, pleural effusion, laryngeal edema
Give antihistamines or corticosteroids at the same time to reduce side effects
Associated with severe encephalopathy if<unk>  burden is high
Starting doses should be divided into BID or TID doses starting at 3-6mg/day and doubling daily until up to 400mg/day is reached
Side effects occur in >50% of people – pruritus, rashes, edema, headaches, fever, pleural effusion, laryngeal edema
Give antihistamines or corticosteroids at the same time to reduce side effects
Second Line Treament
Ivermectin kills only larvae so is not curative, may be more effective if given monthly
Given as a single dose 150 ug/kg, then repeated every 1-3 months
Albendazole kills only adult worms so is not curative, treatment is very slow, and may not be effective if high worm burden
Given as 200mg BID for 21 days
Both treatments may be more effective as a therapy to decrease disease burden so that follow-up treatment with DEC is less likely to cause encephalopathy
Given as a single dose 150 ug/kg, then repeated every 1-3 months
Given as 200mg BID for 21 days
Loa loa
Papules
Agent orange
Insect bites
Pepper spray
Scabies
Monkeypox
Seabather's eruption