Bristle Worm-Induced Keratouveitis: A Case Report

Cornea. 2020 May;39(5):654-656. doi: 10.1097/ICO.0000000000002225.


Purpose: To report keratouveitis arising from corneal penetration by a bristle worm seta (bristle).

Methods: We report on a 64-year-old woman presenting with uniocular pain, redness, reduced vision, discharge, and pustular rash of the hands after cleaning out her marine aquarium containing bristle worms and rubbing her eye.

Results: Slit-lamp biomicroscopy showed pseudomembranous conjunctivitis, corneal punctate erosions, stromal infiltrate, and edema, but no visible foreign body. The anterior chamber developed 3+ cells with hypopyon within 24 hours. Laboratory testing of corneal and hand samples was negative. In vivo confocal microscopy revealed a hair-like seta in the anterior corneal stroma, 25 to 105 μm wide, with surrounding inflammatory cells. Anterior chamber washout was performed. Topical prednisolone 0.5% was commenced, and corneal edema gradually resolved over 3 months.

Conclusions: Bristle worms thrive as detritivores in marine aquarium sediment. Aquarium owners risk touching their setae during tank cleaning. Ophthalmia nodosa describes ocular reaction to caterpillar, vegetable, and spider hairs: features include posterior migration of hairs, granulomatous inflammation, and uncertain prognosis. Eye specialists should be alerted to the possibility of bristle worm-induced ophthalmia nodosa. Confocal microscopy may be useful in identifying microscopic setae.

Publication types

  • Case Reports

MeSH terms

  • Animals
  • Cornea / parasitology
  • Cornea / pathology*
  • Diagnosis, Differential
  • Eye Foreign Bodies / complications*
  • Eye Foreign Bodies / diagnosis
  • Eye Foreign Bodies / parasitology
  • Eye Infections, Parasitic / diagnosis*
  • Eye Infections, Parasitic / etiology
  • Eye Infections, Parasitic / parasitology
  • Female
  • Humans
  • Keratitis / diagnosis*
  • Keratitis / etiology
  • Keratitis / parasitology
  • Microscopy, Confocal
  • Middle Aged
  • Slit Lamp Microscopy
  • Spiders