Ophthalmia Nodosa Type 4: Clinical Course And Management With Topical Steroids In A Filipino Male

Out-Patient Department of a Tertiary Government Hospital in the Philippines

Ophthalmic nodosa is an inflammatory eye condition caused by insect hair, or plant material entering the eye structures through direct contact or via wind-borne setae, with manifestations ranging from mild surface reactions to serious issues requiring vitrectomy. This is a case of a 25-year-old Filipino male presenting with anterior chamber setae causing iritis, managed conservatively with topical steroids, and followed up closely for several months. He presented with redness of the right eye after being hit by a caterpillar directly in the eye while riding a motorcycle. Examination revealed numerous setae on the bulbar conjunctiva, corneal stroma, and anterior chamber, causing iritis. Anterior segment optical coherence tomography (AS-OCT) is useful for the localization and determination of the depth of setae. Serial manual setae removal along the ocular surface and topical corticosteroid treatment were performed. After several months, vision improved to 20/20 and eye redness resolved. Medical management with long-term follow-up may be a treatment option for setae located in the anterior chamber. Early removal of accessible setae must be performed as a precautionary measure to prevent intraocular migration.

The study highlights the importance of prompt diagnosis and treatment in managing Ophthalmia Nodosa. Delayed management can lead to severe inflammation, prompting for more invasive treatment, and sometimes may further result to vision loss. Early intervention with steroids and anti-inflammatory medications, with the advanced types of Ophthalmia Nodosa usually warranting combination of treatment, is crucial in preventing long-term damage to the eye.