Managing multiple caterpillar hair in the eye

Abstract

Ophthalmia nodosa with vitreoretinal involvement is rare and may cause permanent loss of eye due to persistent inflammation of the eye. A young female patient having multiple caterpillar hair in the eye including cornea, anterior chamber, sclera, and pars plana presented with recurrent vitritis and pars planitis. Ultrasound biomicroscopy played a vital role and helped in localizing the hair embedded in the pars plana region which were managed by pars plana vitrectomy leading to complete recovery.

Focal cortical cataract due to caterpillar hair migration

“…Reports on the toxicity of this insect can be found in medical and veterinary literature. Most cases are European or Indian, but toxicity by similar lepidopters (an order of insects that includes butterflies and moths) has also been reported in Australia…”

“…It has been suggested that movement produced by pulse and respiration propels the setae. In the eye, ductions, iris movement and blinking probably contribute to hair migration . It has been recently reported that the accidental ingestion of similar caterpillars ( Ochrogaster lunifer ) induces fetal loss in pregnant mares.…”

“…Vitreoretinal damage has been rarely reported . These patients can develop persistent vitritis or retinochoroiditis.…”

Missed caterpillar cilia in the eye: cause for ongoing ocular inflammation

“…Ocular involvement may occur in the form of conjunctival nodule, keratoconjunctivitis, uveitis, focal cataract and endophthalmitis 1. The caterpillar cilia have a typical property of migrating deep into the tissue with time and causing low-grade chronic inflammation due to the release of toxin thaumetopoein 2. Therefore, careful removal of all the cilia is essential to prevent delayed complications like migration of these cilia in the posterior segment.…”

Intra-lenticular caterpillar seta in ophthalmia nodosa

“…Delayed onset of posterior segment inflammation ranging from weeks to years 1 , 5 , 9 , 10 from the caterpillar contact mandates a high index of suspicion. Specific history of insect injury is crucial to clinch the diagnosis, as often the fine setae or their broken barbs are invisible.…”