|Year : 1976 | Volume
| Issue : 3 | Page : 14-17
Ocular injuries due to caterpillar hairs
SS Grewal, RN Sud
Department of Ophthalmology, Dayanand Medical College, Ludhiana-Punjab, India
S S Grewal
Department of Ophthalmology, Dayanand Medical College, Ludhiana-Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Grewal S S, Sud R N. Ocular injuries due to caterpillar hairs. Indian J Ophthalmol 1976;24:14-7
Ophthalmia nodosa is defined as an inflamatory reaction in the eye to certain insect or vegetable hairs. Cases have been recorded in literature from time to time during the last 120 years. The first description was published by Schon and further cases attributable to caterpillar hairs have been described by others,,,,.
Caterpillar hairs may be blown into the conjunctival fornices by the wind, may penetrate the conjunctiva or cornea forcibly as missile, may get into the eye by direct contact or by being rubbed in when a towel is used. The initial reaction is followed by a variable quiescent interval during which the hairs migrate through the ocular tissues and then severe inflamation recurs.
The cammon lesions seen are allergic dermatitis, caterrhal conjunctivitis, with marginal keratitis, nodular conjunctivitis, localised or diffuw e keratitis, iridocyclitis with or wi hout hypopyon, granulomatous iritis ; and panophthalmitis.
We report 4 cases of ocular injury due to caterpillar hairs.
A 53 years old male patient, farmer by occupation, presented with a history of redness, foreign body sensation, watering and pain in right eye for past 8 days. The symptoms started after wiping his face with a towel. Examination of the right eye showed oedema of lids, mucopurulent discharge at the inner canthus, diminished interpalpebral aperture, marked conjuctival congestion both palpebral and bulbar, bulbar congestion being more marked near the limbus from 4 to 6 o'Clock meridian; and on slit lamp examination presence of six tiny hairs in lower half of cornea, one being embedded in its deeper layers. Anterior chamber, iris and lens were normal. Left eye was normal. Patient was admitted in the hospital the same day.
Removal of the hairs on the cornea of right eye was undertaken the next day under general anaesthesia and with the help of an operating microscope. All the hairs except one which was lying deep and parallel with the plane of cornea, were removed. Achromycin and atropine were instilled into the eye and it was padded. Two days later the lower half of the cornea in the same eye showed criss-cross lines staining with flourescein and this led us to examine the lower palpebral conjunctiva again; and this on Slit lamp examination showed the presence of six tiny hairs embedded in it, surrounded by areas of reaction around them. These were not seen on first day even with slit lamp. Upper palpebral conjunctiva did not show the presence of any hair. The hairs on the lower palpebral conjunctiva were then removed with the help of slit lamp. Next day two more hairs appeared protruding out from lower palpebral conjunctiva which were removed. Subsequent daily examination did not reveal any more hair. Re-examination of the right eye showed the presence of one hair on the cornea which was lying deep and parallel to the plane of corneal lamellae. No hairs were seen on the conjunctiva. Congestion of conjunctiva and cornea was markedly less. He was advised to use achromycin oil suspension 3 times daily. 3 months later one hair lying deep in the cornea was still there and eye was quiet. [Figure - 1]
25 years, male patient, farmer by occupation, presented himself with history of foreign body sensation, redness and watering of right eye for four days, after he had wiped his face with a towel. He got some treatment elsewhere but without relief. Examination of right eye showed the presence of lacrimation and decreased interpalpebral aperture due to oedema of lids. Upper palpebral conjunctiva showed marked congestion and two tiny caterpillar hairs in lateral parts, one in subtarsal sulcus and another one near the posterior border of lid margin. Lower palpebral and bulbar conjunctiva were also congested. Cornea showed criss-cross lines, staining with fluorescein in the lateral part, and absence of any catterpillar hairs. Left eye was normal.
A diagnosis of caterpillar hairs upper palpebral conjunctiva right eye was made.
The caterpillar hairs on the palpebral conjunctiva were removed with the help of slit lamp and patient was advised to use genticyn eye drops two hourly. Patient was alright within 2-3 days time.
A 26 years old, female patient, teacher by profession, presented herself with the chief complaint of pain, redness, watering and foreign body sensation of right eye for past one day. She had similar complaints in the same eye one month earlier and symptoms then started in the morning on waking up and she felt as if something had gone into her eye and was alright in 3 weeks' time with the use of some eye drops locally.
Examination of the right eye showed a rounded, raised hyperaemic area 2 mm. in diameter with a tiny hair in the middle part of tarsal conjunctiva of upper lid. Lower palpebral conjunctiva was normal. Bulbar conjunctiva showed congestion in upper and nasal parts. Cornea showed abrasions in the medial half, but no hairs were seen on the cornea. Left eye was normal.
The patient was free from all the symptoms within 2-3 days of the treatment. [Figure - 2]
A 60 years old male patient, priest by profession coming from a village, presented himself with history of foreign body sensation and watering from left eye for the last one month. The patient did not remember much about the onset. He had some treatment but without relief. Examination of left eye showed a tiny hair struck in the upper palpebral conjunctiva just near the posterior border at about the middle. There was not much reaction surrounding it. The cornea showed a few abrasions in the upper part, but there were no hairs on or in it. Right eye was normal. Removal of the hair was done with the help of a magnifying lens and advised to use chloromycetin and visit eye drops two hourly. Re-examination showed that the patient's eye was completely normal.
| Discussion|| |
There is a general agreement among all authors dealing with this subject on the immediate and severe reaction which occurs as a result of entry of caterpillar hairs into the eye. This is also borne out by our experience with the cases presented. All of our cases presented themselves with sudden onset and almost similar complaints of foreign body sensation, watering and pain ; and right eye was involved in all cases except one. Cornea was involved by caterpillar hairs only in one case, while palpebral conjunctiva (upper in 3 case and lower in one case) was involved in all the four cases.
Bishop and Morton reported 103 cases collected during a period of 16 years from western district of Victoria (Australia) involving palpebral conjunctiva near lid margin, about which there is only scanty mention in the literature. According to the naked eye examination showed minimal signs but inspection of the stained cornea under magnification reveals a distinctive pattern of minute linear scratches of the corneal epithelium which serve to indicate the presence and location of the cause. The scratches are predominantly vertical in the initial stages but later oblique and horizontal abrasions and the lesion may vary from a few small scratches to more extensive areas of denudation of epithelium. Slit lamp examination of everted lid reveals the protruding tip or a minute projecting spicule of caterpilla hair as a dark spot close to the lid margin and surrounded by a small zone of hyperemia. Frequently it is obscured by a tenacious bleb of mucus. The greater part of the hair remains embedded beneath the tarsal conjunctiva with the distal barbed end of the shaft directed away from the lid margin, the proximal tip alone projecting. Presumably this position may be maintained for a considerable time, the natural tendency to forward migration being offset by the backward thrust as it scratches along the corneal epithelium. Clinical picture in our cases resembles that described by Bishop an Morton in their cases, though in all our cases the caterpillar hairs were not necessarily embedded in the palpebral conjunctiva near the lid margin, otherwise the clinical picture in no way differed from theirs. In cases number II and IV the hairs were embedded in palpebral conjunctiva near the lid margin, in case No. I some of the caterpillar hairs were near the lid margin. In case No. III, there was only one hair embedded in tarsal conjunctiva quite away from lid margin. As far as time period is concerned hair may stay embedd d for a long time. In Case No. IV it stayed embedded for one month till it was detected. According to Saraf the incidence of caterpillar hairs involvement is mostly in summer season-generally not after October, though his case came in December. This was explained by him by suggesting that caterpillars of separate families may have a separate life cycle and habits. Bishop and Morton state that while cases occurred throughout the year, the highest incidence was in December and January.
All cases reported here came from end of September to end of February. The incidence of caterpillar hairs involvement in our cases is in accordance with the views and experience of Saraf, and Bishop and Morton. Caterpillars of separate families probably have a separate life cycle and habits.
Gupta and Hari Gopal , reported first case from North India, of caterpillar hairs involvement of the eye. In their case, there were caterpillar hairs in the cornea with surrounding infiltration and many hairs in palpebral conjunctiva. They removed as many hairs as possible except deep ones which were allowed to remain and follow up for a few months showing no adverse reaction in the eye. In our case no. 1, all the hairs were removed except one hair which was lying deep in the cornea and parallel with the plane of the cornea. As has been the experience of Gupta and Hari Gopal, the examination of the eye in this case a few weeks later showed almost no reaction and the hair was occupying the same place. According to Bishop and Morton, the lesion clears rapidly on removal of the cause. This has been our experience too. The lesions cleared completely in a few days time after removal of the cause.
It was surprising that first case reported from North India was in 1968. Probably cases are more frequent and not reported or have been missed because of lack of slit lamp examination. It is our practice to examine all case of foreign body sensation in eye with drop of fluorescein on the slit lamp. Even if no hair is found but there are typical criss cross lines on cornea, patient should be kept under observation and examined daily on the slit lamp as some of the hairs are covered with mucus and missed and others may stay embedded or make their appearance after a few days as is seen in our case no. I.
| Summary|| |
Four cases of ocular involvement by caterpillar hairs are described. Caterpillar hairs were found in the cornea only in one case, while palpebral conjunctiva was involved in all the cases, upper in 3 cases and lower in one case.
Two of our patients were farmers, and one lived in a village, though not farmer by occupation.
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[Figure - 1], [Figure - 2]