Ophthalmia Nodosa

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A 55-year old woman presented with floaters and blurry vision in the right eye, and her best-corrected visual acuity was 20/25. The anterior segment was notable for subtle nummular corneal scars, quiet anterior chamber, and clear lens. There were 1+ cells in the anterior vitreous, multiple linear opacities in the mid-vitreous as shown in the image (the focal plane was set to this mid-vitreous linear opacity), and peripheral chorioretinal scars. The patient said that on a trip to the Brazilian Amazon, she was brushed in the face by a vine inhabited by a caterpillar. She immediately developed foreign body sensation and injection of the right eye but was unable to leave the rainforest for four days.

Ophthalmia nodosa is an ocular inflammatory reaction to foreign bodies such as caterpillar spines and tarantula hairs. The fine, pointed caterpillar setae can migrate into the eye once they make contact with the ocular surface. Movements of the globe and eye rubbing are thought to propel the setae, which travel like an arrow in one direction due to the pointed tip and microscopic barbs that resist backward movement. Over time, these setae may enter the anterior chamber, lens, vitreous, and retina. Toxins within the hollow spine may exacerbate the inflammatory reaction. This condition can lead to chronic conjunctivitis and visually disabling corneal scars, cataract, vitritis, and macular edema. Our patient’s inflammatory condition improved with topical corticosteroid treatment.