Supplementary Material for: Blepharo-keratoconjunctivitis presumably caused by Paederus fuscipes, a beetle: a case report

Toxicity of Paederus species to eyes has scarcely been reported. This report presents a case of chemical blepharo-keratoconjunctivitis with delayed re-epithelialisation caused by Paederus fuscipes in a patient with dry eyes after laser-assisted in situ keratomileusis (LASIK). A 47-year-old woman who had undergone LASIK for myopia 10 years prior experienced visual disturbance and pain in her left eye after being hit by a P. fuscipes insect in her eye 1 day prior to evaluation. At the initial presentation, dermatitis around the patient’s left eye, eyelid oedema, conjunctival chemosis, corneal epithelial defects, and a best-corrected visual acuity (BCVA) of 20/200 were noted. No gram-positive/negative bacteria or indication of cellulitis/elevated inflammation was detected. Administration of antibiotics (topical: cefmenoxime and levofloxacin; intravenous: ceftriaxone) and steroids (betamethasone) improved the non-infectious chemical blepharo-keratoconjunctivitis; however, the large corneal epithelial defect remained for 10 days. Switching from betamethasone to a preservative-free form facilitated re-epithelialisation, and the patient’s BCVA improved to 20/16 after 2 months. Ophthalmologists should consider the toxicity of the Paederus species on the ocular surface and eyelid.