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Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 417-418  

Nairobi eye – “Wake and see” disease

Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India

Date of Submission10-May-2021
Date of Decision17-Jul-2021
Date of Acceptance03-Aug-2021
Date of Web Publication02-Nov-2022

Correspondence Address:
Kaliaperumal Karthikeyan
Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Puducherry - 605 107
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ojo.ojo_145_21

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Keywords: Nairobi eye, night burn, Paederus

How to cite this article:
Sadhasivamohan A, Palaniappan V, Karthikeyan K. Nairobi eye – “Wake and see” disease. Oman J Ophthalmol 2022;15:417-8

How to cite this URL:
Sadhasivamohan A, Palaniappan V, Karthikeyan K. Nairobi eye – “Wake and see” disease. Oman J Ophthalmol [serial online] 2022 [cited 2023 Mar 26];15:417-8. Available from: https://www.ojoonline.org/text.asp?2022/15/3/417/360394

A 36-year-old South Indian female presented with bilateral eyelid and periorbital swelling with pustulation for 1 day duration [Figure 1]a and [Figure 1]b. She had noticed the lesions immediately after waking up in the morning, associated with severe burning sensation and itching over the site. The patient revealed that she had travelled to her farmhouse the day before, where she noticed several black and bright red beetles [Figure 2]. There was no visual disturbance. Her conjunctiva was not congested and cornea was clear.
Figure 1: Evolution of the lesion. (a) (Day 1), (b) (day 2): Bilateral periorbital edema and erythema with pustulation. (c) (Day 5): Resolving lesion with crust. (d) (Day 10): Lesions healed with post-inflammatory hyperpigmentation.

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Figure 2: Paederus beetles

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The characteristic morphology of skin lesions, regional prevalence and identification of the insect helped us in diagnosing this case as periocular Paederus dermatitis (Nairobi eye), as per the criteria given by Karthikeyan and Kumar.[1] She was managed with cold compresses, oral cefixime, antihistamines and analgesics for 5 days with topical mometasone-fusidic acid cream for 7 days. She was continuously followed up to watch for any complications. The lesions resolved with mild hyperpigmentation over 10 days [Figure 1]c and [Figure 1]d.

   Discussion Top

The Paederus beetles (Family: Staphylidinae, Order: Coleoptera) are nocturnal predators attracted to bright lights, commonly seen in humid tropical and subtropical areas. The accidental crushing of the beetle releases its coelomic fluid, which contains the vesicant paederin. This results in an acute irritant contact dermatitis. Owing to their nocturnal nature, the lesions are usually noticed on awakening in the morning, hence also termed “night burn” or “wake and see” disease.[1],[2] The most common presentation is linear erythematous plaque with overlying papulovesicular eruptions in the exposed sites accompanied by itching and burning sensation.[3] This is followed by a stage of crusting and desquamation.

Keratoconjunctivitis or periorbital dermatitis due to Paederus beetle is popularly called as “Nairobi eye.”[1] The ocular involvement is usually unilateral in nature.[4] The eyes being an exposed part during sleep, and presence of rugosities, make periorbital area prone to deposition of pederin.[3] The periocular lesion can be either due to the direct contact of the toxin or by accidental transfer through fingers from elsewhere on the skin.[1] The toxin, being a weak base, cannot penetrate the cornea and conjunctiva and hence the damage is limited.[4] Iritis and keratitis may occur secondary to mechanical trauma when a beetle hits the eye with force. The other complications include post-inflammatory hyper pigmentation and temporary blindness. Lesions over the conjunctiva and eyelid heal in about 10 days to 2 weeks, whereas corneal involvement can take up to 50 days for complete healing.[1]

The diagnosis is mostly based on clinical grounds due to the typical presentation. The differential diagnosis to be considered are herpes simplex, herpes zoster ophthalmicus, impetigo, acute allergic or irritant contact dermatitis, millipede dermatitis, phytophotodermatitis, preseptal cellulitis, and dermatitis artefacta.[3],[4] Immediate washing of the contact area with soap and water, wet compresses and topical steroids forms the mainstay of treatment.[1]

The uniqueness in our case is the unusual bilateral presentation of Nairobi eye. Lack of awareness remains a hurdle in curbing this disease, which can lead to severe morbidity if left untreated.


We would like to thank Prof. Sathiah, Professor and Head, Department of Agricultural Entomology, TNAU, Coimbatore, and his research scholars, for helping with the Paederus beetle image.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Karthikeyan K, Kumar A. Paederus dermatitis. Indian J Dermatol Venereol Leprol 2017;83:424-31.  Back to cited text no. 1
[PUBMED]  [Full text]  
Vijayasankar P, Gopinath H, Karthikeyan K. Kissing lesions in paederus dermatitis. Am J Trop Med Hyg 2019;101:5.  Back to cited text no. 2
KC S, Mishra A, KC D, Karn D. Nairobi Eye: A clinicoepidemiological study from a tertiary care center of central Nepal. J Lumbini Med Coll 2020;8:190-4.  Back to cited text no. 3
Verma S, Gupta S. Ocular manifestations due to econda (Paederus sabaeus). Med J Armed Forces India 2012;68:245-8.  Back to cited text no. 4


  [Figure 1], [Figure 2]


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