Acute conjunctivitis and corneal foreign bodies secondary to tarantula hairs.

An otherwise healthy three-year-old boy was referred to the emergency department with a one-day history of redness, pain and sensation of foreign bodies in his left eye. His parents had held a birthday party the day before, during which he was in contact with exotic animals, including a tarantula. No other children at the party were symptomatic. Treatment with erythromycin ointment four times daily was prescribed by the referring physician for possible conjunctivitis. On examination (day 3), the patient’s visual acuity was 20/25 (6/7.5) in each eye. His parents recalled seeing their child start blinking, rubbing his eyes and crying within seconds after holding a Chilean rose tarantula (Figure 1). The ophthalmology service was consulted, and slit-lamp examination showed substantial conjunctival injection, chemosis and numerous intracorneal linear foreign bodies in the left eye (Figure 2A and B). The area primarily affected was the anterior portion of the corneal stroma. The anterior chamber showed no inflammatory reaction. Findings on examination of the posterior segment were unremarkable. The fine barbed hairs from the tarantula were embedded in the cornea and covered by the overlying epithelium of the cornea (no fluorescein staining). We did not attempt to remove the hairs, because it would have required general anesthesia and likely would have led to more localized scarring from trauma associated with the procedure. Treatment with the erythromycin ointment was continued for two weeks, and the patient was given an eye shield to wear to prevent rubbing. On day 32, the patient was symptomatically better, with few episodes of foreign-body sensation and eye redness, and minimal photosensitivity. His vision improved to 20/20 (6/6) in each eye. The tarantula hairs had migrated deeper into the cornea, with increased surrounding stromal haze (Figure 2C). By day 66, a few hairs were found protruding into the anterior chamber, with local reaction. Encapsulation was seen on day 82. Encapsulated barbs were visible at one-year follow-up (Figure 2D). No inflammation of the anterior chamber was noted at any stage of follow-up. At two years following the injury, the patient was asymptomatic, with no further changes in his ocular examination. The corneal endothelial cell density, an indicator of corneal health measured by specular microscopy, did not differ between the eyes (3096 cells/mm2 in the right eye and 3058 cells/mm2 in the left eye).