Christmas Eye

Recently my good friend and colleague Rob Holloway published an excellent paper on the eye condition known as ‘Christmas Eye’, which is an acute toxic corneal inflammation that occurs during the hot, dry summer months in south eastern Australia.  This condition usually occurs any time from mid-November until late February, hence the name Christmas Eye.  It has also been referred to as Albury-Wodonga syndrome, harvester’s eye or seasonal corneal ulcer.  The cases often occur in clusters and the patient history consistently involves some outdoor activity – such as gardening or mowing – in the previous 24 hours.

 

Rob describes how Christmas Eye is a very painful eye condition as it involves extensive full thickness loss of the epithelium on the front surface of the cornea.  The pain is so severe that patients will often present to Emergency Departments of the local hospital in the early hours of the morning.  For many years the cause of Christmas Eye was unknown, however Rob points out in his paper that the causative agent is now thought to be a small beetle of the genus Orthoperus.  These beetles are known to carry the compound Pederin which is released when the insect is crushed on the skin or eye.  Pederin is a powerful inhibitor of protein biosynthesis and miosis, and it also known to cause blistering.  Given these properties, it is not surprising that this compound causes such extensive damage to the surface (epithelium) of the cornea.

 

The good news is – as Rob explains in his article – that Christmas Eye is managed relatively easily with a combination of bandage soft contact lens wear for a few days until the epithelium has healed and a mixture of appropriate prescription eye drops (antibiotics, non-steroidal anti-inflammatories and non-preserved ocular lubricants).  Resolution of Christmas Eye normally only takes a few days as the corneal epithelium heals rapidly and the pain levels diminish quickly as the epithelium recovers.  The majority of patients show normal healing without any adverse effects.