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ARTICLE
Year : 1969  |  Volume : 17  |  Issue : 4  |  Page : 145-150

Ophthalmo-dermatozoosis


1 Bangur Hospital, Calcutta, India
2 Department of Ophthalmology, Bankura Sammilani Medical College, Bankura, West Bengal, India

Date of Web Publication10-Jan-2008

Correspondence Address:
E Ahmed
Bangur Hospital, Calcutta
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Ahmed E, Roy S N. Ophthalmo-dermatozoosis. Indian J Ophthalmol 1969;17:145-50

How to cite this URL:
Ahmed E, Roy S N. Ophthalmo-dermatozoosis. Indian J Ophthalmol [serial online] 1969 [cited 2021 May 6];17:145-50. Available from: https://www.ijo.in/text.asp?1969/17/4/145/38532

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Table 1

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The characteristic lesions of oph­thalmo-dermatozoosis involve the eyelids, the periocular region, and not infrequently the conjunctiva and the cornea. The Paederus dermatozoosis, involving any part of the exposed skin, is caused by irritation by secre­tion of the beetle of genus PAEDE­RUS.

Vorderman [8] described a dermatitis caused by the beetle, P. Peregrinus. Since then some seventeen different species of Paederus beetle have been known to produce similar dermal lesions in different parts of the globe (Somerset [5] ).

In Eastern India the condition is erroneously called "Spider-lick", which is neither due to a spider nor due o its lick. Strickland [7] identified P. fusicipes as the causative agent. According to him, simple crawling accross or touching the skin did not produce any lesion; but when the in­sect was rubbed on the arm there had been erythematous papules after about 48 hours, some of which became vesi­cles during the next 24 hours.

Issac [2],[3] described the life history of P. fuscipes. The beetle breeds in damp porous soil rich in decaying matter near dirty pools of water, where it lays down its eggs. Eggs hatch into larva, then into pupae and finally develop into adult insects.

Somerset [5],[6] believes that most parts of the beetle contain some irritant substance. but the lesions are gene­rally caused by the active secretion from the -,lands near the hindgut, squirted by the insect as a defence mechanism. According to him "the linear wheals with central coagulation surrounded by an area of painful swelling. are very characteristic".

The present communication con­cerns fifty cases of Ophthalmo-der­matozoosis.


  Methods and Material Top


Fifty consecutive cases in varying age-groups having characteristic lesions of Ophthalmo-dermatozoosis, treated at Bankura Medical College hospi­tal between 7.11.67 and 7.4.68, of whom 47 had attended the outpatients and 3 had been admitted in the hos­pital were selected. A detailed his­tory had been elicited in each case. At initial and subsequent visits the lids, periocular region, conjunctiva, cornea and visual acuity were exam­ined as a routine. Additional find­ings, if any, were noted. The onset, the progress and the final clinical pic­ture were regularly charted.

We had the opportunity of examin­ing most of the patients from the early stage of the lesion progressively on­wards and observing some of them daily till the lesion had healed.


  Observations Top


Most of the patients were adult males [Table - 1]. Maximum number of cases (18) were seen during Dec­ember, 1967. About equal number of cases were seen during February '68 (11) and March, 1968 (12), while during January, 1968 only 4 cases were treated. An epidemic pattern of these cases was apparent [Table - 2] as evidenced by attendance of larger number of cases seen on a few single days.

History of insect hit to the eye could be elicited in 42 cases, while 8 patients could not ascribe the lesion to any known cause. Majority of the former group were moving on bi­cycles during the time of the insect hit and most of them stated that the insect had hit the eye during or just after evening. Patients with no his­tory of insect hit became aware of the painful lesion when they awoke the following morning.

Immediate reaction at the time of insect hit was largely negative except­ing pricking sensation and excessive watering, especially in those cases when the insects were: brushed against the eyelids near the medial canthus. Gross symptoms often started appear­ing after 12 hours, which occasionally had been delayed for 24 to 48 hours. A few patients had insomnia due to pain. We had found no evidence of general toxaemia excepting in a few children. One child had a bout of fever, an adult patient became un­conscious and another adult became very ill. But generally most patients considered the incidence of insect hit as inocuous for about 12 hours by which time they became aware of the ocular condition,

Severe pain referred to the peri­ocular region and rapidly spreading oedema usually discovered in the early morning forced them to seek consul­tation. Occasionally the presence of slight pain in a few cases was the cause of unusually late attendance; in two such cases the dermal lesions had progressed to invade the deeper tissues.

48 cases had unilateral and 2 had bilateral involvement. Of the unila­teral series, there had been no side predilection. Both lids with or with­out periocular region of either side were most frequently involved [Table - 3]. Dermal lesions were generally diffuse. Medial half of the lid was more frequently involved. Apart from the lid, alas nasi, root of the nose, zygoma, temple and eyebrows were common sites of involvement Occa­sionally there had been diffuse dermal lesions elsewhere on any part of the exposed skin. Earlobules, lips, fore­arm, side of neck, etc. had also been found to be affected.

Numerical incidence of various fea­tures of the lesion is shown in [Table - 4].


  Dermal Lesions Top


Most of the patients showed an orderly chain of events [Table - 5], which in our opinion, could be almost pathognomonic of Ophthalmo-derma­tozoosis. Erythematous papules deve­lop within about 36 hours after insect hit. Vesicles and pustules are usually seen between 48 and 72 hours, by which time oedema subsides completely. Linear superficial ulcers (Surface co­agulation [Figure - 1]) with prominent vesi­cles and pustules developing on the third or the fourth day, are the most characteristic signs. The ulcers be­come covered within three to five days by thin, pigmented scars [Figure - 2]. The pigmentation may persist for months. A sense of tautness prevails in some patients for about a week after the apparent cure. Thoughout the whole course of the affection the patients have pain and uneasiness.

In those cases where insects had hit the cornea, dermal lesions, were not at all characteristics: some show­ed only oedema of the lids which ra­pidly subsided without developing vesi­cles, pustules and ulcers. The other variations: from the usual chain of events in our series were: (1) Simul­taneous appearance of oedema, papu­les, vesicles and pustules with 24 hours of insect hit in two cases, (2) develop­ment of ulceration delayed for about a week in two cases and (3) bleeding points over and at the edges of the ulcer in one case. Secondary dermal lesions may develop if the patient is not careful to lie on the affected side; in one of our cases the fluid from the ruptured vesicles and pustules trick­led over the root of the nose and reached the medial halves of the lids and side of the nose on the other side producing similar lesions as on the pri­marily affected side,


  Conjunctival and Corneal Lesions Top


Unilateral conjunctivitis is common, though frank conjunctival discharge is infrequent. Conjunctiva may be ge. latinous-looking at times. Chemosis, though occasional, is usually promi­nent. In two cases we observed sub­conjunctival hemorrhage.

Corneal abrasion is not common. Staining with flourescein distinctly re­veals it. Multiple linear scratches may be apparent.


  Course and Complications Top


Majority of our cases had a short­lived course of about one week. For­tunately complications were rare. One patient had been left with linear scars-one along the superior orbital palpebral sulcus and another along the lower orbital margin, seen on the 75th day of insect hit [Figure - 3].


  Management Top


In our series we adopted the follow­ing measures:

1. Intramuscular injections of Cryst. Penicillin 500,000 units twice daily or of Strepto-penicillin (0.5 gm. Streptomycin) once daily for a varying period of 5 to 7 days. This was en­forced in all cases.

2. A broad-spectrum antibiotic eye ointment into the conjunctival sac and over the affected skin area in all cases.

3. Antihistaminics, Vitamin C and analgesics in some cases.

4. Corneal abrasions responded to simple mydriatic and local antibiotic applications.

5. Meticulous care to avoid any pressure or irritation of the affected site, protective goggles and advice to the patients to lie on the affected side were valuable adjuvant measures.


  Discussion Top


Our present study has not been pre­cise because we have not yet been able to collect a living or dead speci­men of the offending insect, the clinical effects of which are said to constitute almost a syndrome and to pursue an experimental study. Based on pre­vious clinical experience (Ahmed [1] , Mukherjee and Ahmed [4] ) and the ob­servations on the present series of cases we have learnt a few things which have not been properly empha­sized in the literature.

Though the incidence of Ophthal­mo-dermatozoosis has been noted by various workers, at all places and in all seasons, yet a seasonal peak has been apparent in our series of cases. We are unable to put forward a plau­sible explanation for the epidemic pattern of some cases, although inci­dence of epidemics has been cited in literature (Somerset [5] ).

The victims are usually hit by the insect during or just after the evening, a fact hitherto unreported. Probably the offending insect is attracted by the fundal glow of the victims. It hits usually the inner side of the eye: of an unguarded individual when he is on a rapidly-moving vehicle. Only rarely the insects get access over the cornea, while mostly they do not reach upto it because of the reflex action of the orbicularis oculi. So more often they are squashed over the lid skin by which time they squirt a noxious fluid.

Though more often the signs are al­most diagnostic of the condition, yet sometimes this may be confused with various other dermal lesions [Table - 6].

Previously we happened to treat such cases with local therapy alone: though cure was usual it took un­necessarily long time and in some cases left unhappy consequences. The rationale of use of parenteral antibio­tics may be:­

(i) to curtail the course to a con­siderable extent,

(ii) to minimise the risk of compli­cations, and

(iii) to combat secondary infection.

The clinical picture of the dermal lesions and the therapeutic success achieved by using systemic antibiotics reasonably suggest that there is an ele­ment of infection in this lesion. Aller­gy cannot be discounted. though topi­cal corticosteroids have been found to aggravate the condition.

Pigmentation of the affected skin, which may persist indefinitely, is a new feature of the lesion not describ­ed earlier.


  Summary Top


Fifty cases, mostly adult males, of Ophthalmo-dermatozoosis have been reviewed. Seasonal incidence with an epidemic pattern is obvious. The clinical features, mostly characteris­tic, may occasionally be confused with other dermal lesions, unless the usual chain of events are followed scrupulously. The occasional con­junctival and corneal lesions resolve with simple treatment but for the der­mal lesions a course of Penicillin or Streptopenicillin intramuscularly in addition to a topical antibiotic oin­ment for about a week has been prov­ed to be therapeutically rewarding.


  Acknowledgement Top


Our sincere thanks are due to Dr. J. Bose for certain suggestions and the Principal-cum-Superintendent of Ban­kura Medical College & Hospital for supplying the hospital records.

 
  References Top

1.
AHMED, E. (1966). Indian Med. Gaz., 6. No. I, 33.  Back to cited text no. 1
    
2.
ISSAC, P. V. (1933). Agriculture and Livestock in India. 3, 33 (Quoted by Somerset. 1961).  Back to cited text no. 2
    
3.
(1934). Indian J. Agric. Sci., 4,200. (Quoted by Somerset, 1961).  Back to cited text no. 3
    
4.
MUKHERJEE. S. and AHMED. E. (1966). J. All India Ophthal. Soc., 14, 178.  Back to cited text no. 4
    
5.
SOMERSET. E. J. Brit. J. Ophthal., 45. 395 (1961).  Back to cited text no. 5
    
6.
(1962). "Ophthalmology in the Tropics". p. 23. Balliere Tindall and Co. London (1962).  Back to cited text no. 6
    
7.
STRICKLAND, C. Indian med. Gaz., 59, 385 (1924).  Back to cited text no. 7
    
8.
VORDERMAN, A. G. (1901). Geneesk. T. Ned. Ind., 41, 282. (Cited by Som­erset, 1961).  Back to cited text no. 8
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]



 

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  In this article
Methods and Material
Observations
Dermal Lesions
Conjunctival and...
Course and Compl...
Management
Discussion
Summary
Acknowledgement
References
Article Figures
Article Tables

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