Posters

Endophthalmitis secondary to type V ophthalmia nodosa: relevance of anamnesis and clinical findings

Poster Details

First Author: I. Sánchez SPAIN

Co Author(s):    A. Hajjar   R. Portilla   P. Ponton   R. Hernandez   E. Salinas   L. Macias     

Abstract Details

Purpose:

To describe the diagnosis and therapeutic management in a patient suffering endophthalmitis secondary to type V ophthalmia nodosa, following ocular exposure to caterpillar called the pine processionary (larval form of the thaumetopoea pityocampa), common in the Mediterranean environment, including the relevance of differential diagnosis with other types of endophthalmitis and the importance of the anamnesis and clinical findings.

Setting:

Department of Ophthalmology, University Hospital of Burgos, Burgos, Spain.

Methods:

A 44-year-old female presented at emergency department with a history of pain and blurred vision in the right eye (RE). Ocular examination showed mobile 3 mm acute hypopyon and severe vitritis. Any systemic diseases, eye surgeries or high-risk sexual behavior were associated. Chest radiograph, HLA typing, blood tests and ocular ultrasound were non pathological. Anterior chamber puncture was performed with diagnostic aqueous humor analysis including cultivation of microbial agents and viral agents determination by PCR, with negative results. Empiric systemic treatment, intravitreal antibiotics and steroids were started, without clinical improvement; eye fundus started showing presence of white vitreous condensations.

Results:

New extended anamnesis was performed looking for risk factors or contacts with animals, patient admitted being in contact with caterpillars, pine processionary, 5 days before. Type V ophthalmia nodosa with endophthalmitis was suspected, 23G pars plana vitrectomy was performed associated with intravitreal and systemic corticosteroids. Patient improved dramatically, intraocular reaction disappeared from anterior chamber with vitritis remission. 3 days later, VA in RE was 0.7/1, and other ocular examination was non pathological. Patient suffered a bronchospasm episode, treated at pneumology department with inhalers after diagnosis of an immunoallergic reaction to thaumetopoea pityocampa.

Conclusions:

Type V Ophthalmia nodosa with vitreoretinal involvement is a rare entity. Trichomes can access vitreous or subretinal space from the anterior chamber through iris or crystalline lens, or from a conjunctival focus through the sclera. The most important feature of this ocular pathology is the quick remission after surgical removal of trichomes by vitrectomy and subsequent treatment with systemic and intravitreal corticosteroids. To get to this stage, proper and complete anamnesis is critical to suspect contact with thaumetopoea pityocampa and therefore differential diagnosis with other forms of endophthalmitis must also be considered.

Financial Disclosure:

NONE