Ophthalmia Nodosa

Ophthalmia Nodosa
Case presentation
Dr. Prince Amissah

Cornea and Anterior Segment
L V Prasad Eye Institute
Hyderabad
INTRODUCTION
Ophthalmia nodosa is an ocular inflammatory condition precipitated by

the embedment and migration of insect hairs, usually caterpillar setae
and seldom tarantula hairs, or vegetable material into various ocular
tissues.
Its name derives from the characteristic nodular immunological

response that occurs within the conjunctiva, as a reaction to either
the mechanical effect and the penetration of the setae or their direct
toxic effect.
The disease spectrum of ocular pathology is associated with the site and
location of the caterpillar hairs, which have a specific property of
migrating deep into the tissue with time and causing low-grade chronic
inflammation
www.lvpei.org
Watson, P G, and D Sevel. “Ophthalmia nodosa.” The British Journal of Ophthalmology vol. 50,4 (1966): 209-17. doi:10.1136/bjo.50.4.209
keratitis
Catarrhal
endophthalmitis
conjunctivitis
Ophthalmia Conjunctival
Focal cataract
Nodosa nodules
Keratoconjuncti
Uveitis
vitis
Iris
nodules
Sahay P, Bari A, Maharana PK, Titiyal JS. Missed caterpillar cilia in the eye: cause for ongoing ocular inflammation. BMJ Case Rep. 2019;12(4):e230275. Published 2019 Apr 15.
www.lvpei.org
doi:10.1136/bcr-2019-230275
CLASSIFICATION
• Acute anaphylactoid toxic reaction to insect hair, which

Type 1 immediately begins with a duration course of a few days,
mainly causing chemosis and inflammation
• Chronic mechanical keratoconjunctivitis caused by hair

Type 2 found in the bulbar or palpebral conjunctiva with foreign
body sensation and linear corneal abrasion
• Formation of grayish-yellow conjunctival granulomas due

Type 3 to subconjunctival or intracorneal setae; patients may
remain asymptomatic
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Cadera W, Pachtman MA, Fountain JA. Ocular lesions caused by caterpillar hairs (ophthalmia nodosa). Can J Ophthalmol. 1984;19:40–44
• Iritis secondary to hair penetration into the anterior
Type 4 segment, which may become severe with iris nodule
formation and hypopyon.
• Early or late vitreoretinal involvement due to penetration

of the hair through the cornea, iris, and lens or via the
Type 5 trans scleral route; vitritis, cystoid macular edema,
papillitis, or endophthalmitis may occur.
Cadera W, Pachtman MA, Fountain JA. Ocular lesions caused by caterpillar hairs (ophthalmia nodosa). Can J Ophthalmol. 1984;19:40–44 www.lvpei.org
Management
Medical
• Copious irrigation with the use of saline solution, followed by the administration of topical
antibiotics and steroids.
• Removal of all insect setae with the use of forceps, including lid eversion.
• Close follow up for at least six months in patients with retained hairs/stingers
Surgical
• Iridectomy
• Lensectomy;
• Nd:YAG laser to disrupt hairs
• Oral, periocular, or intraocular steroids for inflammatory control (but other infections must
be ruled out before ocular injections)
• Vitrectomy for resistant cases .
Moses K.N. (2021) Ophthalmia Nodosa. In: Foster C.S., Anesi S.D., Chang P.Y. (eds) Uveitis. Springer, Cham. https://doi.org/10.1007/978-3-030-52974- www.lvpei.org
1_59
Case History
Demographics
Name: Mr X Age: 22 years Residence: Shirol,Latur,Maharashtra
Profession: Student
History
Presents with sudden onset of pain, redness and tearing when an insect flew into the left eye
whiles on his motor bike
Reported same day elsewhere and treated as a case of left cornea infiltrate with
Gatifloxacin e/d 3-4x/day
Natamycin e/d 3-4x/day
Atropine/d 3x/day
Subsequently referred and seen at LV Prasad the following day
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OS
VA-20/200
Conjunctival congestion +
Corneal epith defect
Paracentral dense stromal

infiltrate1x1mm
Extensive stromal
edema
AC reaction 3+
Trace hypopyon
Posterior seg-WNL
OD-WNL
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Extent of corneal edema and AC reaction is out of proportion to the cellular infiltration-
insect sting injury is a strong possibility :
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Normal left eye B scan
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Corneal scraping-negative smear
Plan of management
 Milflox e/d 6x/day
 Atropine 1% 2x/day
 To start topical steroid if culture negative and infiltrate does not
progress
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One week
Resolving stromal
infiltrate with scarring
Surrounding stromal
edema had cleared
Trace AC reaction
Corneal scraping:
negative smear and
culture
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2 deeply embedded insect
stingers
DM-endothelium complex
spared
Started on predforte e/d

6x/day for 1 week then
tapered off over 5 weeks
VA 20/200->>>20/20
Patient remains
asymtomatic after 5
months
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Points for discussion
When to use antifungals
When to suspect ophthalmia nodosa in the

setting of severe inflammation with edema
Should all cases undergo microbiological

investigation before starting steroids
Prevention
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Thank You

Ophthalmia Nodosa

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Ophthalmia Nodosa

Dr. Prince Amissah

Ophthalmia nodosa is an ocular inflammatory condition precipitated by

Its name derives from the characteristic nodular immunological

• Acute anaphylactoid toxic reaction to insect hair, which

• Chronic mechanical keratoconjunctivitis caused by hair

• Formation of grayish-yellow conjunctival granulomas due

• Early or late vitreoretinal involvement due to penetration

• Nd:YAG laser to disrupt hairs

Corneal epith defect

Paracentral dense stromal

 Milflox e/d 6x/day

 To start topical steroid if culture negative and infiltrate does not

Started on predforte e/d

When to use antifungals

When to suspect ophthalmia nodosa in the

Should all cases undergo microbiological

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