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Onchocerciasis (river blindness)

Onchocercosis (caecitas fluvialis) · Onchocerkóza (říční slepota)

What it is

A threadworm spread by blackflies breeding in fast rivers, over 99% of cases in Africa: its larvae swarm through the skin causing relentless itch, and in the eye they scar the cornea and retina.

Symptoms & signs

  • Intense itching
  • bumpy rash, then thickened, patchy depigmented skin ('leopard skin')
  • firm nodules over bones (hip, ribs, head)
  • red, gritty eyes
  • night blindness and narrowing vision
  • blindness

🚩 Get help if…

  • call 112 / 911 now Sudden loss of vision or very painful red eye
  • see a doctor soon Blurred vision or trouble seeing at night
  • see a doctor soon Constant itchy rash after living near African rivers
  • see a doctor soon Lumps under the skin over the hips or ribs

Where it strikes

Medical treatment

  • Skin snips, antibody test or slit-lamp exam
  • Ivermectin once or twice yearly (donated for mass treatment since 1987) — kills larvae, not adult worms trials support
  • Moxidectin — FDA-approved 2018 from age 12; clears skin larvae for longer than ivermectin mixed evidence
  • ivermectin in heavy Loa loa infection can cause fatal encephalopathy — test first
  • Doxycycline for 6 weeks — kills adult worms via their Wolbachia bacteria mixed evidence
  • surgical removal of nodules

Natural & lifestyle

  • Long sleeves and repellent near rivers
  • larvicide in breeding rivers

Emerging & experimental

  • Drugs that kill adult worms (emodepside in trials)
  • elimination: verified in four countries of the Americas and, in 2025, in Niger

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Neem (Azadirachta indica) extracts — laboratory activity against filarial worms; no human trials early / small studies
  • Shea butter and herbal ointments for itching — soothe the skin; do not touch the worms anecdotal / traditional

ICD codes