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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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Year : 2015  |  Volume : 22  |  Issue : 4  |  Page : 520-521  

Rare presentation of ophthalmia nodosa

1 Department of Ophthalmology, Dr SMCSI Medical College, Karakonam, Kerala, India
2 Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication21-Oct-2015

Correspondence Address:
Shimna Clara Prasad
T.C-7/739 (1), Koura-22, Kannottukonam Lane, Ulloor, Medical College (P), Thiruvananthapuram - 695 011, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-9233.164627

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We report a rare case of ophthalmia nodosa, presenting as a painless swelling in the lower palpebral conjunctiva for 2 years with no signs of inflammation. Excision biopsy confirmed the diagnosis.

Keywords: Caterpillar Hair, Granuloma, Ophthalmia Nodosa

How to cite this article:
Prasad SC, Korah S. Rare presentation of ophthalmia nodosa. Middle East Afr J Ophthalmol 2015;22:520-1

How to cite this URL:
Prasad SC, Korah S. Rare presentation of ophthalmia nodosa. Middle East Afr J Ophthalmol [serial online] 2015 [cited 2022 Jun 28];22:520-1. Available from: http://www.meajo.org/text.asp?2015/22/4/520/164627

   Introduction Top

Ophthalmia nodosa is an inflammation precipitated by hairs of certain insects or vegetable material, and it derives its name from the nodular conjunctival reaction that results.[1],[2] Patients usually present with a severe reaction to the caterpillar hairs and have signs of conjunctivitis and uveitis. We report a rare case of ophthalmia nodosa incidentally detected on routine checkup, as the patient did not have any signs of conjunctivitis or uveitis. Ophthalmia nodosa has not been reported as an incidental finding in the literature.

   Case Report Top

A 40-year-old female reported to the department of ophthalmology, with complaints of defective vision for the past 4 years for which she was using spectacles. She also complained of a swelling in the lower palpebral conjunctiva, which she had noted for the past 2 years. She did not report any history of foreign body sensation, redness, pain, or watering. She did not recall any contact or injury with an insect.

On examination, her best-corrected visual acuity was 6/6, J1 in both eyes. The left eye was normal. Anterior segment evaluation of the right eye revealed a quiet eye with no signs of congestion or inflammation. A 10 mm × 10 mm size nodule was seen in the lower palpebral conjunctiva of the right eye with embedded caterpillar hairs [Figure 1] and [Figure 2].
Figure 1: Granulomatous lesion in the lower palpebral conjunctiva

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Figure 2: Caterpillar hair embedded in the granuloma

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All visible caterpillar hairs were removed from the lesion, and topical steroids were prescribed. However, new hair continued to appear, causing irritation.

An excision biopsy of the granuloma was performed, and the patient symptoms were relieved. Histopathology revealed focal ulceration and secondary histiocytic reaction around linear refractile foreign bodies. No hair follicles were noted.

   Discussion Top

Ophthalmia nodosa is defined as a nodular conjunctival reaction produced as an inflammatory response to certain insects such as caterpillars or to vegetable hairs.[1],[4] Caterpillars are the larval form of a member of the insect order Lepidoptera, which includes butterflies and moths.[3]

Cadera et al.[5] classified Ophthalmia nodosa into five categories:

  • Type 1: Acute anaphylactoid reaction to the hair which begins immediately and lasts a few days causing chemosis and inflammation
  • Type 2: Chronic mechanical keratoconjunctivitis caused by hair which is lodged in the bulbar or palpebral conjunctiva and leads to linear corneal abrasions
  • Type 3: Grayish yellow granulomatous nodule formed in the conjunctiva and the hair may be subconjunctival or intracorneal, but patients may be asymptomatic
  • Type 4: Iritis secondary to hair penetration into the anterior segment and it may become severe with iris nodule formation and hypopyon
  • Type 5: Vitreoretinal involvement after hair penetration into the posterior segment.

The patient in this case report is Type 3 where she had a granulomatous swelling with no signs of conjunctivitis or uveitis.

The differential diagnosis of an asymptomatic nodular conjunctival lesion at this site could be dermoid or chalazion.

Excision biopsy determined the absence of hair follicles, or other sebaceous structures, as would be expected in a dermoid. In addition, the cellular reaction was not suggestive of a chalazion.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Giles CL, Schlaegel TF Jr. Trauma: Inflammation. In: Tasman W, Jaeger EA, editors. Duane's Ophthalmology. Revised Edition. Vol. 4, Ch. 62.1: Lippincott Williams and Wilkins Publishers; 2013.  Back to cited text no. 1
Sengupta S, Reddy PR, Gyatsho J, Ravindran RD, Thiruvengadakrishnan K, Vaidee V. Risk factors for intraocular penetration of caterpillar hair in Ophthalmia nodosa: A retrospective analysis. Indian J Ophthalmol 2010;58:540-3.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
Timucin OB, Baykara M. Role of scheimpflug imaging in the diagnosis and management of keratitis caused by caterpillar seta. Oman J Ophthalmol 2010;3:150-2.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
Watson PG, Sevel D. Ophthalmia nodosa. Br J Ophthalmol 1966;50:209-17.  Back to cited text no. 4
Cadera W, Pachtman MA, Fountain JA, Ellis FD, Wilson FM 2nd. Ocular lesions caused by caterpillar hairs. Can J Ophthalmol 1984;19:40-4.  Back to cited text no. 5


  [Figure 1], [Figure 2]

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