Spiderman's eye

In February, 2009, a 29-year-old man was referred by his general practitioner to our eye casualty with a 3-week history of a red, watery, and photophobic right eye. He had been treated with antibiotic ointment for a presumed conjunctivitis. His Snellen visual acuity in the right eye was reduced to 6/9, whereas his left eye achieved 6/4. On a low-power, slit-lamp examination of the right anterior segment, he had diff use conjunctival injection as well as multiple corneal subepithelial infi ltrates visible as scattered white spots (fi gure A). These initial fi ndings seemed consistent with a viral keratoconjunctivitis. On closer examination with higher magnifi cation, fi ne hair-like projections were seen at the centre of each corneal infi ltrate (fi gure B). These were noted at varying depths within the cornea. Some had migrated through to the innermost endothelial layer provoking mild anterior chamber infl ammation. At this stage, a dilated fundal examination was carried out. It showed one small focus of retinitis in association with a hair-like projection as seen in the cornea. When these fi ndings were described to the patient, he immediately recalled an incident that had preceded the onset of his symptoms. 3 weeks earlier, he had been cleaning the glass tank (terrarium) of his pet, a Chilean Rose tarantula (fi gure C). While his attention was focused on a stubborn stain, he sensed movement in the terrarium. He turned his head and found that the tarantula, which was in close proximity, had released “a mist of hairs” which hit his eyes and face. We attempted removal of corneal hairs for our patient under the operating microscope. They were too fi ne to be amenable to removal even with micro-forceps. We commenced treatment with intensive topical steroids in a tapering regime. As of August, 2009, he complains of intermittent fl oaters and mild discomfort only. His eye is no longer red and his visual acuity has improved to 6/5. He has mild infl ammation in his vitreous, which is treated with a once daily steroid drop. He now wears eye protection before handling the tarantula. The Chilean Rose tarantula (Grammostola rosea) has urticating hairs over the posterior aspect of its body. As a defence mechanism against potential preda tors, the tarantula will rub its hind legs against its abdomen to dislodge these hairs into the air. Multiple barbs allow the hairs to migrate through ocular tissue as well as other surfaces. The infl ammatory reaction observed is termed ophthalmia nodosa; a broad diagnosis covering the response of the eye to insect or vegetable material. A few cases of ophthalmia nodosa secondary to tarantula hairs have been reported. Long-term topical steroid is the only eff ective treatment for this clinical presentation. This case highlights the importance of a collaborative approach between doctor and patient in providing good clinical care. The condition described is rare and the correct diagnosis was made only after we discussed the clinical fi ndings with the patient. Finally, we suggest that tarantula keepers be advised to routinely wear eye protection when handling these animals.