Caterpillar hair-induced ophthalmitis causing exudative retinal detachment

A woman in her 50s presented to our ophthalmology clinic with a history of accidental fall of caterpillar into her left eye 20 days back, while gardening, followed by vigorous rubbing of the eye. She reported diminution of vision in the left eye for past 7 days associated with severe swelling, pain, redness and itching. Visual acuity on presentation was perception of light in left eye with accurate projection of rays in all quadrants, intraocular pressure was 6 mm Hg by non-contact tonometry. Anterior segment evaluation revealed marked eyelid oedema, conjunctival congestion, multiple foci of subconjunctival abscesses, embedded caterpillar hairs in the tarsal, bulbar conjunctiva and cornea. Anterior chamber evaluation revealed 3+ aqueous cells and 2+ aqueous flare. Posterior synechiae was seen involving five clock hours in the superotemporal quadrant (figure 1A). Subconjunctival abscess in the inferonasal quadrant with embedded caterpillar hair is shown in figure 1B. Fundus examination showed bullous exudative retinal detachment in the inferonasal quadrant corresponding to the subconjunctival abscess. Ultrasound B scan confirmed retinal detachment (figure 2A). Anterior segment and posterior segment examination of the right eye was within normal limits. © BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.