|Year : 1969 | Volume
| Issue : 4 | Page : 145-150
E Ahmed1, SN Roy2
1 Bangur Hospital, Calcutta, India
2 Department of Ophthalmology, Bankura Sammilani Medical College, Bankura, West Bengal, India
|Date of Web Publication||10-Jan-2008|
Bangur Hospital, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ahmed E, Roy S N. Ophthalmo-dermatozoosis. Indian J Ophthalmol 1969;17:145-50
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  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  ).
In Eastern India the condition is erroneously called "Spider-lick", which is neither due to a spider nor due o its lick. Strickland  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 , 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 , 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|| |
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|| |
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|| |
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|| |
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|| |
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|| |
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|| |
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  , Mukherjee and Ahmed  ) 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  ).
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|| |
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|| |
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|| |
AHMED, E. (1966). Indian Med. Gaz., 6. No. I, 33.
ISSAC, P. V. (1933). Agriculture and Livestock in India. 3, 33 (Quoted by Somerset. 1961).
(1934). Indian J. Agric. Sci., 4,200. (Quoted by Somerset, 1961).
MUKHERJEE. S. and AHMED. E. (1966). J. All India Ophthal. Soc., 14, 178.
SOMERSET. E. J. Brit. J. Ophthal., 45. 395 (1961).
(1962). "Ophthalmology in the Tropics". p. 23. Balliere Tindall and Co. London (1962).
STRICKLAND, C. Indian med. Gaz., 59, 385 (1924).
VORDERMAN, A. G. (1901). Geneesk. T. Ned. Ind., 41, 282. (Cited by Somerset, 1961).
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]