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   Table of Contents      
CASE REPORT
Year : 1984  |  Volume : 32  |  Issue : 1  |  Page : 29-30

Beetle injury of cornea


Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Kanwar Mohan
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012
India
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Source of Support: None, Conflict of Interest: None


PMID: 6500661

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How to cite this article:
Mohan K, Jain S, Sen N, Dhir S P. Beetle injury of cornea. Indian J Ophthalmol 1984;32:29-30

How to cite this URL:
Mohan K, Jain S, Sen N, Dhir S P. Beetle injury of cornea. Indian J Ophthalmol [serial online] 1984 [cited 2020 Oct 26];32:29-30. Available from: https://www.ijo.in/text.asp?1984/32/1/29/27364

The entry of insects into the eye may cause severe irritative symptoms which are often aggravated by the poisonous effects of their body juices, stings or bites. A violent keratitis and iridocyclitis following bee and wasp stings, caterpillar hairs and injury by many other insects, has been well documented in the. literature. Corneal injury by beetle is an extremely rare condition and to the best of our knowledge there is no case report of the same available in the literature. However a necrotic conjunctivitis with clouding of cornea and iritis has been reported following instillation of Canthridine (Linde[1]-1898, Hilbert 2--1903)­the toxic fluid present in the blood of a num­ber of insects especially beetles (Duke Elder 3-1972).

Because of its extreme rarity, we report a case of beetle injury of cornea with retained intracorneal leg spurs of the insect.


  Case Top


S.S. 25 years M (AO 39764) presented with the history of accidental hit to the right eye by some insect while driving motor cycle 2 mon­ths back following which he started having persistent pain, redness, foreign body sensa­tion and gradually progressive diminution of vision in that eye. Patient was treated by the local practitioner with Soframycin and atr­opine eye drops TDS and Ridinox eye drops. Q.LD. for 1'h months but did not get much relief and came to this institution.

Visual acuity was counting finger 1 metre in right eye and 6/5 in left eye. Examination of the right eye revealed very little conjunctival congestion and two dense infiltrates in the Central Part of Cornea; the upper one being larger [Figure - 1] with a faint black spot visible in the centre of the upper infiltrate. The sur­rounding cornea was hazy. Pupil was atro­pinised. A yellowish white exudate like material was seen on the anterior lens surface. I.O.P. was normal. Slit lamp examination showed two dark brown sting like bodies in the upper corneal infiltrate. These were almost in the same track with' some gap in bet­ween with deeper one touching the endo­thelium where as the superficial one in the anterior corneal stroma. Epithelium was intact. There were no signs of active uveitis, however few pigments were seen on the pos­terior corneal surface. Lens showed anterior polar cataract. A presumptive diagnosis of sting injury of cornea by some insect was made and patient was treated with atropine eye drops BD and Betnesol Eye drops TDS by which cornea cleared slightly. 3 days later the superficial sting like body was removed from the cornea and subjected to detailed micros­copic examination by Entomologist which revealed it to be a thin, smooth and non hollow process with blunt tip [Figure - 2]-con­sistent with the spur of leg of some beetle and differentiating it from the sting which in con­trast is thick, hollow, sharp tipped and mostly single. However the exact identification of the species of beetle was not possible. The second spur being situated deep in the cornea couldn't be removed. After removal of the spur, cornea became much clearer but sti1l corneal inflammation was persisting. The e was no visual improvement owing to the pre­sence of anterior polar cataract in addition.


  Discussion Top


A violent iridocyclitis and keratitis follow­ing ocular injury by insects is though partly due to mechanical insult, is largely the result of Chemical Injury by toxic fluid produced by the insects as a defence mechanism. None of the beetles possess a venomous sting or bite but hundreds of species of beetles are known to exude a toxic fluid containing cantharidin crystalline anhydride of cantharidic acid ­which produces severe vesicant reaction on the skin 3 and when instilled into the eye, it gives rise to necrotic conjunctivitis and keratouveitis. The severe Keratitis and anterior polar cataract as a sequelae of anterior uveitis in the present case most pro­bably resulted from the cantharidin contain­ing toxic fluid exuded by the beetle at the time of injury. In addition, the leg spurs though embedded in the cornea but being chemically inert might have added some mechanical insult to the cornea.

Identification of the causative insect by the patient at times may be extremely difficult especially in speedy driving moments as has been in the present case also where only mic­roscopic examination of the left out part of the insect (leg spurs) in the cornea by the Ento­mologist could establish the diagnosis of bee­tle injury.

It being mainly a chemical injury, not much improvement is expected by the removal of the left out leg spurs in the cornea. Keratitis and Uveitis can be treated by the usual topical steroid and atropine therapy. Response to medication, however, is very slow as is evident from the present case where keratitis still persisted after about 3 months of treatment, though uveitis got controlled. The final visual outcome is also uncertain because of the associated sequelae of keratouveitis.


  Summary Top


An extremely rare case of beetle injury of cornea with retained intracorneal leg spurs of the insect is reported.

 
  References Top

1.
Duke Elder S., 1972, System of Ophthalmology Vol. XIV, Part 2 Page 1203 Henry Kimpton, LONDON.  Back to cited text no. 1
    


    Figures

  [Figure - 1], [Figure - 2]



 

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