Case Study: February 2011


  • A 35 year old female with irritation in left eye.
  • Examination reveals a yellowish nodule in inferior conjunctival fornix with surrounding vascular congestion.
  • Thought to be a ‘maggot’.
  • Removed and shelled out nicely.


  1. Is it a maggot?
  2. What is the histological reaction pattern observed?
  3. What further investigations could be done?
  4. What is the likeliest diagnosis?
  5. What would you recommend to the clinician.
Click to show answers
  1. No !!
  2. Necrobiotic, palisaded granuloma.
  3. Bug stains (including stains for mycobacteria). All negative in this case. Fibrin stain (negative in this case).
  4. Pseudorheumatoid nodule or granuloma annulare of the conjunctiva / episclera.
  5. Ask about whether patient is diabetic. Connective tissue disorder screen as some can be associated with lupus.


Episcleral and orbital pseudorheumatoid nodules.Ross MJ, Cohen KL, Peiffer RL Jr, Grimson BS. Arch Ophthalmol. 1983 Mar;101(3):418-21.

Periocular pseudo-rheumatoid nodules commonly affect the orbital rim. Sharma A, Shortt A, Meligonis G, Rose GE Orbit. 2008;27(5):341-4.

Juvenile, insulin-dependent diabetes mellitus, type 1-related dermatoses. Sehgal V, Bhattacharya S, Verma P. J Eur Acad Dermatol Venereol. 2010 Nov 25