Multimodal Imaging Characterization of Butterfly Hair–Induced Keratitis

Purpose: Multimodal imaging was performed to characterize butterfly hair–induced keratitis based on anterior segment optical coherence tomography and in vivo confocal microscopy. Methods: This study was a case report. Results: A 6-year-old girl presented with acute keratitis induced by multiple butterfly hairs. Severe itching and pain developed immediately after rubbing her left eye, leading to significant pain and moderate vision loss, even after undergoing twice removal of the corneal epithelium. The hair-like foreign bodies were distributed at various depths inside the corneal stroma, even extending into the anterior chamber. The symptoms and corneal infiltration gradually decreased within 6 months with the use of topical steroids and immunosuppressors. The hairs located in the superficial and middle stromal layers of the cornea disappeared at the 6-month follow-up, but the hairs in the deep stromal layer tended to move deeper. The diagnosis was confirmed by in vivo confocal microscopy and microphotography. The migration tendency of the hairs into the intraocular space was observed using anterior segment optical coherence tomography (AS-OCT). Conclusions: Butterfly hair–induced keratitis can be controlled by the treatment with topical steroids and immunosuppressors, but the hairs tend to move into the eyes. To the best of our knowledge, this is the first case of corneal in vivo confocal imaging of butterfly hairs.