Eyeworld

N EWS PRESENTATION SPOTLIGHT Contact information Bierman: lbierman@tuftsmedicalcenter.org Rao: Naveen.k.rao@lahey.org by Stefanie Petrou Binder, MD EyeWorld Contributing Writer among other things. Granulomatous nodules on the conjunctiva and iris give this entity its name. Case Presentation A 27-year-old female presented to Naveen Rao, MD, with pain, tearing, and ocular redness 2 days after a large, black caterpillar was swatted into her left eye. Upon presentation, the patient had 20/20 visual acuity, IOP within normal limits, and no anterior or posterior segment inflammation. Slit lamp photographs of the left eye demonstrated trace conjunctival injection near the limbus with one caterpillar setae embed- ded in the conjunctiva and multiple caterpillar setae embedded in the corneal stroma. Anterior segment OCT of the affected eye demonstrat- ed a setae embedded in the corneal stroma, extending down to Descemet's membrane and threatening to penetrate through to the anterior chamber. Caterpillar setae can be missed due to the strong inflammatory response, which can make identification of these subtle hairs difficult, ac- cording to a study that looked at 29 eyes of 17 patients with ophthalmia nodosa, often necessi- tating multiple patient visits to ensure complete removal. Patients in the study described foreign body sensation, photophobia, lacrimation, red- ness, and eyelid edema, with hairs found in the conjunctiva, cornea, and anterior chamber. 1 The patient was diagnosed with oph- thalmia nodosa and a treatment strategy was devised. It included meticulous removal of all visible setae, bandage contact lens placement, and ther- apy with gatifloxacin q2h, pred- nisolone TID, cyclopentolate QHS. For the best management of the inflammation, the doc- tor recommended that spe- cialists consider both ocular and systemic corticosteroids and antibiotics. Vitreoretinal surgery could be considered an option, if indicated. A n interesting case report on ophthal- mia nodosa, a rare ocular inflamma- tion caused by caterpillar spines and tarantula hairs that lodge into the ocular tissues, describes the advan- tage of quick action to reduce the inflammatory reaction elicited by setae within the eye and details the best way to redirect the embedded spines for easier remov- al. An e-poster describing the causes, incidence, clinical manifestations, and management of ophthalmia nodosa was presented by Lauren Bierman, MD, at the 2019 ASCRS ASOA An- nual Meeting. Ophthalmia nodosa is an ocular inflam- matory reaction brought about by exposure to very particular types of foreign bodies, name- ly caterpillar spines and tarantula hairs. The very fine, pointed setae enter the eye through direct contact with the ocular surface, travelling through the ocular tissues in a straight line due to their pointed tips and microscopic barbs prevent backward motion. Toxins within the hollow spine further drive the inflammatory reaction, leading to chronic conjunctivitis, cor- neal scars, cataract, vitritis, and macular edema, Caterpillar spines and tarantula hairs are tricky to remove About the doctor Lauren Bierman, MD New England Eye Center Boston Naveen Rao, MD Lahey Hospital and Medical Center Burlington, Massachusetts References 1.Doshi P, et al. A Hairy affair: ophthalmia nodosa due to caterpillar hairs. Ocul Immunol In- flamm. 2018;26(1):136–141. 2. Hom-Choudhury A, et al. A Hairy affair: tarantula setae-in- duced panuveitis requiring pars plana vitrectomy. Int Ophthalmol. 2012 Apr;32(2):161–3. 3. Agarwal M, et al. Indian J Oph- thalmol. 2017 Mar;65(3):248– 250. Relevant financial interests Bierman: None Rao: None 28 | EYEWORLD | DECEMBER 2019

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