|Year : 1984 | Volume
| Issue : 1 | Page : 29-30
Beetle injury of cornea
Kanwar Mohan, Sandeep Jain, N Sen, SP Dhir
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012
Source of Support: None, Conflict of Interest: None
|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
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-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|| |
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|| |
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|| |
An extremely rare case of beetle injury of cornea with retained intracorneal leg spurs of the insect is reported.
| References|| |
Duke Elder S., 1972, System of Ophthalmology Vol. XIV, Part 2 Page 1203 Henry Kimpton, LONDON.
[Figure - 1], [Figure - 2]