|
|
BRIEF COMMUNICATION |
|
Year : 2010 | Volume
: 58
| Issue : 6 | Page : 540-543 |
|
Risk factors for intraocular penetration of caterpillar hair in Ophthalmia Nodosa: A retrospective analysis
Sabyasachi Sengupta, Padmati Ravindranath Reddy, Jamyang Gyatsho, Ravilla D Ravindran, Krishnan Thiruvengadakrishnan, Vikram Vaidee
Department of Cornea and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
Date of Submission | 15-Feb-2010 |
Date of Acceptance | 02-Jun-2010 |
Date of Web Publication | 16-Oct-2010 |
Correspondence Address: Sabyasachi Sengupta Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry - 605 007 India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0301-4738.71711
We report risk factors associated with intraocular penetration of caterpillar hair seen at our institute from January 2005 to December 2007. Records of all patients with caterpillar hair induced ophthalmitis (CHIO) were retrospectively reviewed for clinical characteristics, anatomic location of lodgment of the caterpillar hair, treatment methods, and outcomes. Out of a total of 544 cases of CHIO, 19 eyes (seven in the anterior chamber and 12 in the posterior segment) experienced intraocular penetration (3.5%). The presence of deep intracorneal hair (80 cases, 14.7%) was found to be the only risk factor for intraocular penetration ( P < 0.001). The removal of intracorneal hair was possible in only 29 out of 80 eyes (36%) and this was associated with a significantly reduced risk of intraocular penetration ( P = 0.022). Patients with retained intracorneal hairs should be counseled regarding risk of intraocular penetration and closely followed up for at least six months. Keywords: Caterpillar hair, intraocular penetration, ophthalmitis
How to cite this article: Sengupta S, Reddy PR, Gyatsho J, Ravindran RD, Thiruvengadakrishnan K, Vaidee V. Risk factors for intraocular penetration of caterpillar hair in Ophthalmia Nodosa: A retrospective analysis. Indian J Ophthalmol 2010;58:540-3 |
Caterpillar hair induced ophthalmitis (CHIO) is an inflammatory response of ocular tissue to caterpillar hair or other insect hair (tarantula hair) that come in contact with the eye. It is usually an innocuous condition and responds readily to conservative management. However, a small number of patients experience intraocular penetration of caterpillar hair, with potentially disastrous complications. Most existing literature on intraocular penetration of caterpillar hair is in the form of anecdotal case reports and small case series. [1],[2],[3],[4],[5],[6],[7],[8],[9] However, risk factors that may predict the occurrence of this event have not been elucidated. The basis of our study was to identify the risk factors that predict intraocular penetration of caterpillar hair.
Materials and Methods | | |
Medical records of all cases of CHIO diagnosed from January 2005 to December 2007 were drawn from a computerized data base. The demographic features, clinical features, medical and surgical treatments, and outcomes of the therapy were reviewed. All patients underwent slit-lamp examination and indirect ophthalmoscopy to determine the anatomical location as well as the number of caterpillar hair. Pediatric patients (one month to 10 years) were evaluated under general anesthesia (EUGA) and operating microscope if required. The clinical manifestations varied significantly and were classified into various types as suggested by Cadera et al. [9]
Type I: An acute, anaphylactoid reaction to the hair, starting immediately and lasting a few days, causing chemosis and inflammation.
Type II: Chronic mechanical kerato conjunctivitis caused by hair lodged in the bulbar or palpebral conjunctiva, leading to linear corneal abrasions.
Type III: Formation of grayish-yellow granulomatous nodules in the conjunctiva. The hair may be subconjunctival or intracorneal and may be asymptomatic.
Type IV: Iritis secondary to hair penetration into the anterior segment. The iritis may be very severe with iris nodule formation and even a hypopyon.
Type V: Vitreoretinal involvement after hair penetration into the posterior segment.
As a routine, on the first visit, an attempt to remove the visible superficial hair was made by the treating ophthalmologist. Medical therapy varied between lubricants and antibiotic eye ointments, with a bandage and additional topical steroids, when granulomatous inflammation (nodule) was observed. Systemic steroids were resorted to when posterior segment involvement was seen. Risk factors for intraocular penetration were analyzed using the Fischer's exact test and Chi-square test.
Results | | |
A total of 544 eyes with CHIO were identified over a three-year study period, out of which 19 eyes developed intraocular penetration (3.5%) of hair. The mean age was 33.64 years (Range from one month to 83 years). [Figure 1] shows the distribution of patients according to the type of reaction. Anatomical location of the lodgment of the caterpillar hair is shown in [Table 1].
Out of the 80 eyes with intracorneal hair at presentation, 19 eyes (23.75%) demonstrated intraocular migration. Presence of intracorneal hair was the only factor that was significantly associated with penetration of hairs ( P < 0.001). Successful removal of the hair was possible in only 29 instances (36%), while in the remaining 51 eyes (64%), they were retained [Figure 2]. Eyes with complete removal of the hair experienced significantly lesser intraocular penetration (6.9%) compared to those eyes in which the hair was retained (33.33%) (P = 0.02). Other risk factors considered for intraocular migration did not reach statistical significance [Table 2]. | Table 2: Analysis of risk factors associated with intraocular penetration of caterpillar hair
Click here to view |
| Figure 2: Retained intracorneal setae, tangential to the corneal curvature, with minimal surrounding congestion
Click here to view |
Intraocular penetration of hair into the iris, vitreous, and retina were seen at variable intervals ranging from a few days to as long as six months from the initial presentation on the ocular surface. One patient with intravitreal hair developed persistent vitritis and received 4 mg / 0.1 ml intravitreal triamcinolone acetonide (IVTA) injection to control inflammation at the three-month follow-up. Three patients with retinochoroiditis were well-controlled with a short course of oral steroids. One pediatric patient experienced endophthalmitis with retinal detachment within three weeks, finally resulting in phthisis bulbi. Hair isolated from the conjunctiva was studied randomly under the light microscope, at 40X magnification, in 12 of the cases. Two different varieties were seen, one with spines along the shaft [Figure 3] and the other without spines [Figure 4]. | Figure 3: Caterpillar hair at 40× magnification showing spines along the shaft with epithelial debris adherent to the spines
Click here to view |
| Figure 4: Caterpillar hair at 40× magnification with no spines along the shaft
Click here to view |
Discussion | | |
The prevalence of CHIO is high in this part of the world as evidenced by our large sample over a relatively short period of time. To the best of our knowledge, this is the first study evaluating the risk factors for intraocular penetration of caterpillar hair.
We found the presence of intracorneal hair to be the only significant risk factor for intraocular penetration, with potentially devastating complications. Successful removal of all intracorneal hair led to a significant reduction in the risk of intraocular penetration. However, it is very difficult to remove the hair in all instances due to their extreme friability, accompanying corneal edema, surrounding infiltration, and deep lying hair. Most patients have more than one hair, all of which may not be amenable for removal at the first sitting. Thus, patients with retained intracorneal hair must be followed up closely as vision-threatening complications may develop late in the course of the disease.
The pathological damage caused by a caterpillar hair is a function of its direct toxicity and locomotion. The force with which the hair strikes the eye may determine the risk of intraocular penetration. However, the quantum of hair present on the ocular surface and direct contact with a caterpillar do not influence the risk of penetration as seen from our analysis.
Frank endophthalmitis is very rare, although mild grades of vitritis have been more commonly reported. Posterior segment involvement may occur early or even years later. The majority of patients with vitreoretinal hair, in our series, did not have anterior chamber hair favoring transcleral penetration. Late onset endophthalmitis requiring vitrectomy has been reported despite adequate treatment of the anterior segment manifestations. [2],[3]
In conclusion, a majority of the cases of CHIO are limited to manifestations of the type I to type III variety, which respond well to removal of the hair and standard topical steroid management. The prognosis is relatively good even with intraocular penetration of the hair. Despite the grave range of possibilities in the manifestations, the outcome in most of the cases is satisfactory, if diagnosed early and treated appropriately. The presence of intracorneal hair is a significant risk factor for intraocular penetration.
References | | |
1. | Horng CT, Chou PI, Liang JB. Caterpillar setae in the deep cornea and anterior chamber. Am J Ophthalmol 2000;129:384-5. [ PUBMED] [ FULLTEXT] |
2. | Steele C, Lucas DR, Ridgway AE. Endophthalmitis due to caterpillar setae: surgical removal and electron microscopic appearances of the setae. Br J Ophthalmol 1984;68:284-8. [ PUBMED] [ FULLTEXT] |
3. | Shibui H, Kawashima H, Kamata K, Sasaki H, Inoda S, Shimizu H. Vitrectomy for caterpillar seta-induced endophthalmitis. Arch Ophthalmol 1997;115:555-6. [ PUBMED] [ FULLTEXT] |
4. | Imaizumi A, Koike N, Kimu M, Shirota Y. A case of intractable uveitis induced by urticating hair of caterpillar. Jpn J Clin Ophthalmol 2003;57:471-5. |
5. | Conrath J, Hadjadj E, Balansard B, Ridings B. Caterpillar setae induced acute anterior uveitis: a case report. Am J Ophthalmol 2000;130:841-3. [ PUBMED] [ FULLTEXT] |
6. | Rishi P, Agarwal M, Mahajan S, Rishi E. Management of intralenticular caterpillar setae. Indian J Ophthalmol 2008;56:437-8. [ PUBMED] |
7. | Bhende M, Biswas J, Sharma T, Chopra SK, Gopal L, Shroff CM. Ultrasound biomicroscopy in the diagnosis and management of pars planitis caused by caterpillar hairs. Am J Ophthalmol 2000;130:125-6. [ PUBMED] [ FULLTEXT] |
8. | Raspiller A, Lepori JC, George JL. Chorioretinopathy caused by migration of a caterpillar hair. Bull Mem Soc Fr Ophtalmol 1983;95:153-6. [ PUBMED] |
9. | Cadera W, Pachtman MA, Fountain JA, Ellis FD, Wilson FM. Ocular lesions caused by caterpillar hairs. Can J Ophthalmol 1984;19:40-4. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]
This article has been cited by | 1 |
Multimodal Imaging Characterization of Butterfly Hair–Induced Keratitis |
|
| Yue Yuan, Shanshan Wang, Dadong Guo, Zengchao Zhao, Fangqiang Zheng, YongYu Xu, Ziqun Jin, Hongsheng Bi, Ying Wen | | Cornea. 2024; | | [Pubmed] | [DOI] | | 2 |
A red and watering eye |
|
| Koushik Tripathy, Aneesha M Ichlangod, Uma Sridhar, Milap Vaghela | | BMJ. 2023; : e076442 | | [Pubmed] | [DOI] | | 3 |
Ophthalmia nodosa secondary to intraocular, white-marked tussock caterpillar setae (Orgyia leucostigma) in a 15-year-old |
|
| Sydney Levy, Molly Posa, Maria Kelly, J Reeves Samaha, Jaclyn Otero | | SAGE Open Medical Case Reports. 2023; 11: 2050313X23 | | [Pubmed] | [DOI] | | 4 |
Delayed presentation, deeper peril: Ophthalmia nodosa |
|
| Agrima Bhatia, Pawan Gampa Kumar, S. Mohan, Hemant Singh Trehan, Sridhara Reddy | | Kerala Journal of Ophthalmology. 2023; 35(1): 86 | | [Pubmed] | [DOI] | | 5 |
A case of panuveitis caused by caterpillar setae |
|
| Ying Zhang, Yuan Yuan, Ruyi Zhao, Wei Tan | | European Journal of Ophthalmology. 2023; | | [Pubmed] | [DOI] | | 6 |
Ocular Injuries Due to Insect Spines (Ophthalmia Nodosa): Potential Hazard to Motorcyclists |
|
| Sarah Sathyapriya Tamilarsan, Juanarita Jaafar, Tan Chew-Ean, Nurul Ain Masnon, Wan-Hazabbah Wan Hitam | | Cureus. 2022; | | [Pubmed] | [DOI] | | 7 |
Ophthalmia nodosa presenting as pan-uveitis and infective scleral abscess |
|
| Radhika Thundikandy, Rajesh Vedhanayaki, S Anjana, SR Rathinam | | Indian Journal of Ophthalmology - Case Reports. 2022; 2(3): 688 | | [Pubmed] | [DOI] | | 8 |
Anterior segment optical coherence tomography characteristics and management of a unique spectrum of foreign bodies in the cornea and anterior chamber |
|
| Mona Bhargava, Varsha Bhambhani, RajS Paul | | Indian Journal of Ophthalmology. 2022; 70(12): 4284 | | [Pubmed] | [DOI] | | 9 |
Corneal epithelial ingrowth after perforating corneal injury: a case report |
|
| Adrien Quintin, Loïc Hamon, Fidelis A. Flockerzi, Ursula Schlötzer-Schrehardt, Matthias Dias Blak, Berthold Seitz | | BMC Ophthalmology. 2022; 22(1) | | [Pubmed] | [DOI] | | 10 |
Multiple migratory caterpillar hairs in the eye – A case report |
|
| Kaaviya Asokan, Juhy Cherian, Venipriya Vijay, Hannah Ranjee Prasanth, Renuka Srinivasan | | Indian Journal of Clinical and Experimental Ophthalmology. 2022; 8(4): 559 | | [Pubmed] | [DOI] | | 11 |
Clinical and histopathological features of conjunctival “Teddy bear” granuloma: A case series |
|
| Alejandra Lozano-Bustillo, Dolores Ríos y Valles-Valles, Ivette Hernández-Ayuso, Abelardo A. Rodríguez-Reyes | | European Journal of Ophthalmology. 2022; : 1120672122 | | [Pubmed] | [DOI] | | 12 |
Caterpillar hair-induced ophthalmitis causing exudative retinal detachment |
|
| Bijnya Panda, Shilpa Viswanath, Sucheta Parija, Bhumija Bhatt | | BMJ Case Reports. 2022; 15(7): e251145 | | [Pubmed] | [DOI] | | 13 |
Vertical scan imaging of Anterior Segment Optical Coherence Tomography for descemet anchoring caterpillar seta: A case report and review of literature |
|
| Mona Bhargava, Varsha G. Bhambhani, Raj Shekhar Paul | | American Journal of Ophthalmology Case Reports. 2022; : 101671 | | [Pubmed] | [DOI] | | 14 |
Multimodal imaging in the diagnosis and management of ophthalmia nodosa |
|
| Noy Ashkenazy, Philip J. Rosenfeld, Janet L. Davis | | American Journal of Ophthalmology Case Reports. 2022; : 101692 | | [Pubmed] | [DOI] | | 15 |
Augenreizung nach Fahrradtour durch Münster |
|
| Maximilian Treder, Martin Dominik Leclaire, Friederike Vietmeier, Constantin E. Uhlig, Maged Alnawaiseh, Nicole Eter, Lamis Baydoun | | Der Ophthalmologe. 2021; 118(5): 504 | | [Pubmed] | [DOI] | | 16 |
Clinical profile and outcomes of ophthalmia nodosa in South India: A retrospective study |
|
| Kanika Chhabra, Pankaja Dhoble, Vaibhav Khanna | | Kerala Journal of Ophthalmology. 2021; 33(2): 142 | | [Pubmed] | [DOI] | | 17 |
Ophthalmia nodosa secondary to multiple intraocular caterpillar hairs in a 2-year-old girl |
|
| AbdulazizI Al Somali, Wael Otaif, TamerM Afifi, UssamaA Moustsfa, KhalidE Emara | | Saudi Journal of Ophthalmology. 2020; 34(3): 230 | | [Pubmed] | [DOI] | | 18 |
Comparing in-vivo confocal microscopy and ex-vivo light and scanning electron microscopy images of the hairs of the pine processionary caterpillar embedded in the cornea: Report of three cases |
|
| Francisco Pérez-Bartolomé, Jorge Peraza-Nieves, JI Fernández-Vigo, Rosalía Méndez-Fernández, Julio Gonzalez Martín-Moro, Pedro Arriola-Villalobos | | Indian Journal of Ophthalmology. 2020; 68(8): 1672 | | [Pubmed] | [DOI] | | 19 |
Moth hair in cornea in a case of seasonal hyperacute panuveitis |
|
| Ranju Kharel (Sitaula), Pratap Karki, SagunN Joshi, AnandaK Sharma, MadanP Upadhyay | | Indian Journal of Ophthalmology. 2020; 68(5): 930 | | [Pubmed] | [DOI] | | 20 |
Bristle Worm-Induced Keratouveitis: A Case Report |
|
| Jonathan Kirk, David Gunn, Nathan Wong, Emily Minchin, Kieren Darcy | | Cornea. 2020; 39(5): 654 | | [Pubmed] | [DOI] | | 21 |
A Rare Hideout for Caterpillar Hairs |
|
| Jayagayathri Rajagopalan, Anupama Joy, Dayakar Yadalla, Fatima Amanath Assadi | | Ophthalmic Plastic & Reconstructive Surgery. 2020; 36(4): e93 | | [Pubmed] | [DOI] | | 22 |
In Vivo Confocal Microscopy of Pine Processionary Caterpillar Hair–Induced Keratitis |
|
| Rémy Jullienne,Zhiguo He,Pierre Manoli,Damien Grivet,Elisa Cinotti,Jean Luc Perrot,Bruno Labeille,Frédéric Cambazard,Philippe Gain,Gilles Thuret | | Cornea. 2015; : 1 | | [Pubmed] | [DOI] | | 23 |
Corneal Inflammation From Pine Processionary Caterpillar Hairs |
|
| Alejandro Portero,Ester Carreño,David Galarreta,José M. Herreras | | Cornea. 2013; 32(2): 161 | | [Pubmed] | [DOI] | | 24 |
Ophthalmia Nodosa as an Occupational Disease: Is It Usual or Is It Casual? |
|
| Arzu Taskiran Comez,Hasan Ali Tufan,Baran Gencer | | Ocular Immunology and Inflammation. 2013; 21(2): 144 | | [Pubmed] | [DOI] | | 25 |
High Prevalence of Anelloviruses in Vitreous Fluid of Children With Seasonal Hyperacute Panuveitis |
|
| S. L. Smits,A. Manandhar,F. B. van Loenen,M. van Leeuwen,G. S. Baarsma,N. Dorrestijn,A. D. M. E. Osterhaus,T. P. Margolis,G. M. G. M. Verjans | | Journal of Infectious Diseases. 2012; 205(12): 1877 | | [Pubmed] | [DOI] | | 26 |
High prevalence of anelloviruses in vitreous fluid of children with seasonal hyperacute panuveitis |
|
| Smits, S.L., Manandhar, A., Van Loenen, F.B., Van Leeuwen, M., Baarsma, G.S., Dorrestijn, N., Osterhaus, A.D.M.E., (...), Verjans, G.M.G.M. | | Journal of Infectious Diseases. 2012; 205(12): 1877-1884 | | [Pubmed] | | 27 |
Seasonal hyperacute panuveitis: An update |
|
| Manandhar, A. | | Current Opinion in Ophthalmology. 2011; 22(6): 496-501 | | [Pubmed] | | 28 |
Seasonal hyperacute panuveitis |
|
| Anu Manandhar | | Current Opinion in Ophthalmology. 2011; 22(6): 496 | | [Pubmed] | [DOI] | |
|
|
|
|