Infective keratitis and chronic anterior uveitis induced by a marine bristleworm cheta corneal foreign body injury: a case report

Session Details

Session Title: Infections

Session Date/Time: Sunday 23/09/2018 | 16:30-18:00

Paper Time: 17:24

Venue: Room A3, Podium 3

First Author: : J.Kirk UK

Co Author(s): :    D. Gunn   K. Darcy                 

Abstract Details

Purpose:

To present the first ever report of ocular injury caused by marine bristleworm chetae (chitinous bristles), including description and imaging of clinical features, treatment and clinical course.

Setting:

Diagnosis, treatment and ongoing review occurred through the corneal service of a tertiary referral eye hospital (Bristol Eye Hospital). Confocal microscopy was performed at Moorfields Eye Hospital, London.

Methods:

We describe a 64-year-old female non contact lens wearer who developed acute onset monocular pain, redness and reduced visual acuity to 2/60 after cleaning out her saltwater aquarium and rubbing her eye. An initial presumptive diagnosis of infective keratitis with hypopyon was made based on clinical findings and treatment initiated with intensive empirical antibiotic treatment (0.5% Levofloxacin and 5% Cefuroxime). Slow clinical improvement, further enquiry and corneal imaging led to the discovery of a corneal intrastromal cheta foreign body from marine bristleworms seen in the aquarium by the patient. Treatment, clinical progress and results of further investigations are described.

Results:

Examination revealed a corneal epithelial defect, stromal infiltrate and oedema, pseudomembrane, hypopyon, with cellulitis and pustules of the hands. Photographs of anterior segment findings and hands are provided. Corneal scrape was negative. Slit lamp examination revealed no ocular surface, corneal or intraocular foreign body. OCT-A changes were consistent but no corneal foreign body was identified. Confocal microscopy revealed a fine, hyper-reflective hair-like structure at a corneal depth of 140-180 microns with associated inflammatory cells. Anterior chamber washout was performed. After topical steroid treatment (Predsol) for 2 months, the patient has VA of 6/36, improving corneal stromal haze and anterior uveitis.

Conclusions:

Saltwater aquaria are increasingly popular and the source of a $330 million dollar worldwide annual trade (Source: UN). Bristleworms are aquatic worms commonly introduced to aquaria as hitch-hikers on living coral and tolerated by aquarists do to their detritivore action. Their protective chetae break when touched and in some species are barbed or deliver a toxin. Case reports of caterpillar hair related ocular injury highlighted the risks of ophthalmia nodosa, progressive intraocular migration of hairs, and endophthalmitis. Ocular injury from bristleworm chetae represents a similar mechanism and should be considered in aquarium hobbyists. Confocal microscopy was invaluable in confirming diagnosis.

Financial Disclosure:

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