The Multiple Faces of Setae Induced Ocular Inflammation (Ophthalmia Nodosa): A Review

Ophthalmia nodosa is an inflammatory ocular condition caused by the penetration of arthropod hairs (setae) into the eye. This review aims to systematize current knowledge on the condition, identify knowledge gaps, and propose an updated classification.

A systematic literature review was conducted in July 2024 in PubMed and Cochrane Central. Articles focusing on non-ophthalmological manifestations, zoological aspects, or cases in animals were excluded. Relevant data were extracted from each study, including demographic information, causal species, clinical manifestations, and disease classification.

A total of 112 articles were included in the review, with 84 addressing caterpillar-related cases and 28 focusing on tarantula-related cases. The condition was most frequently reported in India and Europe. In Europe, the processionary caterpillar is a common cause. Cases involving tarantulas are typically linked to domestic incidents. Most cases result in mild inflammation, but in some instances, intraocular penetration leads to severe complications, including irreversible visual loss. Diagnosis relies primarily on slit-lamp examination, but OCT and confocal microscopy improve setae detection. The review also highlights the limitations of Cadera's classification, as disease progression does not always follow its defined stages.

Ophthalmia nodosa remains an underrecognized cause of ocular inflammation. While advances in corticosteroid therapy and vitrectomy have improved outcomes, knowledge gaps persist, particularly regarding the pathogenesis of seasonal hyperacute panuveitis (SHAPU). A new classification system is proposed to better reflect disease progression and improve clinical management.