Acute Keratoconjunctivitis Induced by Pine Processionary Caterpillar Hairs (Thaumetopoea pityocampa): A Case Report and Literature Review.
Aouni Jaafer J, Loukil Hajer H, Sioud Sabri S, Dlensi Aryj A et al.
The pine processionary caterpillar (Thaumetopoea pityocampa) is an important cause of environmental exposure in Mediterranean regions. Its urticating hairs can induce ocular inflammation ranging from superficial conjunctivitis to keratitis and, rarely, intraocular complications. With the recent expansion of its geographical distribution, awareness of this condition is increasingly important among ophthalmologists, particularly in areas where exposure may be overlooked. We report the case of a 43-year-old male farmer presenting with a 5-day history of unilateral ocular redness, foreign-body sensation, tearing, and pain in the left eye. Slit-lamp examination revealed conjunctival chemosis and multiple fine brownish hairs embedded beneath the corneal epithelium and within the anterior stroma, associated with mild stromal edema and superficial punctate keratitis. Best-corrected visual acuity was 5/10, with no anterior chamber or posterior segment involvement. Anterior segment optical coherence tomography demonstrated linear hyperreflective structures corresponding to retained corneal foreign material. A detailed occupational history revealed exposure to pine processionary caterpillars during forestry work, leading to the diagnosis of acute keratoconjunctivitis (ophthalmia nodosa) secondary to T. pityocampa hairs. The retained setae were removed under slit-lamp guidance using a G25 needle after topical anesthesia with benoxinate hydrochloride 0.4% eye drops. Treatment consisted of topical dexamethasone 0.1% with progressive tapering and topical ofloxacin 0.3%. Clinical improvement was rapid, with complete visual recovery within 2 weeks. Specular microscopy demonstrated preserved endothelial function, with stable endothelial parameters during the 6-month follow-up period. Ocular exposure to T. pityocampa hairs should be considered in patients with unexplained keratoconjunctivitis, especially those with occupational or environmental exposure. Early recognition, complete removal of retained hairs, and careful monitoring are essential to prevent migration and vision-threatening complications. This case highlights the importance of clinician awareness as the distribution of this species continues to expand.