|Year : 1982 | Volume
| Issue : 1 | Page : 11-14
PK Sethi, N Dwivedi
Department of Ophthalmology, M.G.M. Medical College and M. Y. Hospital, Indore, India
P K Sethi
Department of Ophthalmology, M.G.M. Medical College and M.Y. Hospital, Indore
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sethi P K, Dwivedi N. Ophthalmia nodosa. Indian J Ophthalmol 1982;30:11-4
Ophthalmia Nodosa derives its name from the nodular conjunctival reaction produced as an inflammatory response to certain insect or vegetable hairs. Very few cases have been reported from this country ,,,,
The following is a report of four interesting cases of Ophthalmia Nodosa.
| Case reports|| |
Case No. 1 : J. 60 years, Female, attended the Ophthalmic O.P.D. with a history of a caterpillar wandering over the left upper lid while she was sleeping about a month back. She noticed foreign body and pricking sensations in the left eye about three hours later. Four days later she had redness, watering and difficulty in opening the lids. After a week she took treatment from two different Eye Hospitals for about two or three weeks with no amelioration of symptoms.
On examination the V.A. was 6/12 RE and 6/60 LE. On the left side the lids were oedematous and she had photophobia, lacrimation and blepharospasm in addition to pricking sensation. On slit lamp examination the cornea showed punctate stippling and vertical and oblique superficial linear scratches which stained with fluorescein. On everting the upper lid four yellow round raised soft follicular lesions I to 2 mm in diameter were seen. Dark brown hair were projecting from these follicles seen under the slit lamp. They were picked up with a fine forceps and mounted on a glass slide with egg albumin coating. The microscopic picture was of a sharp smooth hair with a central core and no barbs [Figure - 1]. Within a week the symptoms were relieved.
She came 6 months later with a single sharply linear recurrent corneal erosion in the same eye. No caterpillar hair could be detected at this time. Treatment with local antibiotics, atropine, pad and bandage resulted in a clinical cure in four days. She was prescribed glasses for her compound myopic astigmatism.
Case No. 2: A.N. 7 years, Male, attended the Ophthalmic O.P.D. with a history of sustaining an insect bite while sleeping in the second week of October. An hour later his mother noticed a swelling of the eye lids of the right side and she also picked a few hair from the skin of the right upper lid. After a few hours he complained of pricking sensation, watering, redness and difficulty in opening the lids. Four days later he was treated as a case of corneal ulcer. He had a partial amelioration of symptoms but some photophobia, redness, lacrimation and itching persisted. He was admitted to the Ophthalmic Ward. On everting the upper lid raised yellow round soft follicle like lesions were seen. From four of these black hair were projecting and were pulled out by fine forceps under the slit lamp. The next day two more hair were seen projecting from the remaining follicles and these were also removed. In the lower and temporal areas of the cornea near the limbus there was a faint staining with fluorescein. There were also punctate spots and vertical and oblique superficial linear scratches in the cornea. He was asymptomatic a week later and the visual acuity was 6/12 RE and 6/6 LE. He was followed up for a year during which period he remained asymptomatic.
Case No. 3: C. 33 years, Male, attended the Ophthalmic O.P.D. with a history of a caterpillar falling on the left eye three days back while he was clearing the roof. He complained of a pricking sensation. On examination there was a slight swelling of the left upper lid and a mild conjunctival and ciliary flush. Examination of the everted lid by slit lamp released a single yellow follicle. Deep in the follicle there was a fine black point. The follicle was ruptured with the forceps and its base gently stroked. This resulted in a caterpillar hair popping out and this was pulled out with fine forceps.
Case No. 4: S. 16 years, Female, attended the Ophthalmic O.P.D. with a history of a caterpillar crawling over the left eye while she was sleeping about three weeks earlier. She then developed pricking sensation, itching, redness and lacrimation. On examination the V.A. was 6/9 RE and 6/9 LE. On the left side there was a mild conjunctival and ciliary flush. Slit lamp examination of the everted left upper lid showed fine yellow round soft raised follicles. From three of these caterpillar hair were. seen projecting out. These were pulled out with fine forceps. The remaining two follicles which did not show any hair were ruptured and their bases were stroked with the forceps. This resulted in two more black caterpillar hair popping out which were then pulled out. In the cornea there was a fine punctate stippling and vertical and oblique fine linear scratches which stained with fluorescein. There was a small single caterpillar hair in the superficial stroma of the cornea on the temporal side. This was surrounded by a faint zone of infiltration. The corneal hair could not be removed and so the area was carbolized, antibiotics and atropine instilled and the eye bandaged. A corneal opacity was then seen around the corneal hair but the eye remained asymptomatic for the next three months. The hair, however, continued to remain as such in the same place in the cornea.
| Discussion|| |
The black and the brown hairy caterpillars belong to the order Lepidoptera. Geserick , observed a seasonal incidence between July and November and the autumn as the usual season. The incidence of Ophthalmia Nodosa has essentially to depend on the life cycle of the caterpillar in the locality. Out of the six cases reported from India so far, four cases were reported to occur between September and December. We could not obtain information about the other two cases. The time of encounter with the caterpillar in our four cases was one each in the last week of September and the first week of January and two in the month of October. Thus in India Ophthalmia Nodosa is common in the winter months when the caterpillars are in plenty.
Unlike most of the cases reported, all the cases in our series encountered the caterpillars in the house itself, mostly while asleep. The caterpillars tend to seek dark and secluded places for pupation and for this reason they may wander into the houses.
Duke Elder  described that after the initial symptoms of trauma there was a quiescent interval followed by a recurrence of symptoms. He mentioned the quiescent interval to be usually several weeks and occasionally three to five days. In our series of quiescent interval was very short. It was three hours in the first case, a few hours in the second, less than three days in the third and an indeterminate period of less than three weeks in the fourth cases. Our observations are unconformity with those of other reports from India in the cases reported by Patel and Shanbhag.
Most of the Western. literature has reported barbed hair in their cases which must be dependant on the type of the caterpillar existing there. In all our cases the caterpillar hair was sharp, smooth and without barbs. It is possible that the shorter quiescent interval in the cases from India may be due to the quicker and easier passage of the smooth and sharp hair through the tissues of the lid aided by the muscular movements of the lids and by rubbing the lids on account of irritation.
The tissue reaction to the caterpillar hair in the palpebral conjunctiva is due to the mechanical and toxic effects. Clinically, there were four types of presentations of the caterpillar hair in the palpebral conjunctiva. Firstly, cases in which the hair was projecting out from the yellow follicle for a short distance. In these cases the sharp point scratched the cornea on lid movements (Case Nos. 1, 2 and 4). Secondly, cases in which the hair remained embedded and could only be seen as a black point deep in the substance of the follicle (Case No. 3). Thirdly, cases in which follicles were seen apparently without any hair but on subsequent followup the hair projected out from the same follicle (Case No. 2). Fourthly, cases in which no hair was visible but on mechanically rupturing the follicle and gently stroking its base the caterpillar hair could be coaxed out (Case No. 4).
The corneal lesions produced by the hair partially embedded in the lids were punctate stippling of the cornea and vertical and oblique superficial scratches demonstrable by fluorescein staining and slit lamp examination. We had the impression that the longer the duration of the time of encounter with the caterpillar, the greater the number of scratches over the cornea. In one case there was a recurrent erosion of the cornea six months later (Case No. 1). In our series caterpillar hair in the cornea occurred in only one case (Case No. 4). The fine linear hair was in the superficial layers of the cornea. This was surrounded by a faint zone of infiltration. As the hair could not be removed and the lesion was in the corneal periphery, it was carbolized. This resulted in the prevention of migration of the hair on a three month followup.
If a history of encounter with a caterpillar is obtained, all follicular lesions in the conjunctiva should be potentially considered to harbour caterpillar hair and attempts should be made to coax out the hair from the substance of the follicle.
| Summary|| |
The clinical features of Ophthalmia Nodosa differ slightly in India. The seasonal incidence is from September end to January beginning. There is a shorter quiescent interval due to the hair being sharp and smooth and without barbs.
| References|| |
Bose, 1950, Cited by Duke-Elder and MacFaul 1972.
Gupta, J.S. and Hari Gopal, 1968, Orient Arch. Ophthalmol. 6 : 306.
Patel, R.J. and Shanbhag, R.M., Ind. J. Ophthalmol 21 : 208.
Ranga Reddy, P. and Shiva Reddy, P., 1977, Proc. All India Ophthalmol. Soc. 33: 173.
Geserick, 1952, Cited by Duke-Elder and MacFaul, 1972.
Duke-Elder, Sir S. and MacFaul, P.A., 1972. System of Ophthalmology, London, Henry Kimpton, Vol. XIV, Part 2, pp. 1197-1202.
Saraf, G.K., 1967,: Orient. Arch. Opthalmol. 5:57. Schon, 1861 : Cited by Duke-Elder and MacFaul. 1972.
[Figure - 1]