BMJ Case Reports 2018; doi:10.1136/bcr-2018-224194
  • Images in…

Images in ophthalmia nodosa: an unusual presentation of red eye

  1. Fiona Carley FRCOphth3
  1. 1Ophthalmology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, Shropshire, UK
  2. 2Stroke Medicine, Wye Valley NHS Trust, Hereford, Herefordshire, UK
  3. 3Ophthalmology, Manchester Royal Eye Hospital, Manchester, Greater Manchester, UK
  1. Correspondence to Dr Nicholas David St John Savage, nicksavage{at}
  • Accepted 20 February 2018
  • Published 9 March 2018


Caterpillars, tarantulas and vegetation produce a variety of defence fibres (called setae) uniquely adapted to penetrate the tissues of their target.1 Ophthalmia nodosa (ON) is an ocular inflammatory reaction resulting from these setae entering the eye. Microscopic barbs on the surface of setae facilitate their entry into the cornea with subsequent migration to underlying structures leading to potentially sight-threatening conditions such as vitritis and endophthalmitis.2

A 41-year-old man presented to Manchester Royal Eye Hospital with a 6-day history of unilateral left-sided red eye and pain secondary to a caterpillar falling into his eye while on an adventure holiday (figure 1). Prior to presenting in the UK, he had sought initial medical attention in the USA, where multiple foreign bodies were noted. He was treated with chloramphenicol eye ointment, and no follow-up was arranged.

Figure 1

Acute red eye and visible seta on cornea.

On re-presentation in the UK, slit-lamp examination revealed setae embedded within his conjunctiva and eyelids causing multiple corneal abrasions. There was no evidence of intraocular inflammation. Optic disc and macula were normal. Visual acuity was 6/6 in both eyes.

The patient was taken …

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