Abstract
Nasal myiasis is an exceptionally rare parasitic infestation caused by dipteran fly larvae invading the nasal cavity, typically occurring in immunocompromised individuals or those with poor sanitation exposure. This report presents the first case of nasal myiasis following primary ocular involvement in an otherwise healthy immunocompetent Syrian woman, challenging the classical understanding of risk factors and pathogenesis. The patient initially presented with unilateral ocular symptoms including foreign body sensation and photophobia, with subsequent mechanical extraction of larvae. Ten days later she developed bilateral nasal symptoms including larval expulsion, nasal obstruction and hyposmia. CT scan demonstrated right maxillary sinus mucosal thickening with an irregular hyperdense lesion at its superolateral aspect. The patient underwent functional endoscopic sinus surgery with povidone-iodine irrigation and oral ivermectin therapy, resulting in complete symptom resolution. This case demonstrates that even brief environmental exposures (sheep area exposure in this instance) can lead to sequential ocular-nasal infestation in immunocompetent hosts. The successful treatment with combined surgical and medical therapy provides valuable insights for managing similar cases where mechanical extraction alone may be insufficient. Clinicians should maintain high suspicion for myiasis in patients with characteristic symptoms regardless of immune status, particularly after animal exposure or rural activities. The case highlights the importance of preventive measures including protective eyewear and masks in high-risk environments, and demonstrates the effectiveness of combined surgical and pharmacological intervention in refractory cases.