Corneal bee sting with retained stinger

Management of Secondary Keratouveitis in a Wasp Sting Patient in a Jungle Region of Peru

Wasp stings are considered an ophthalmological emergency as they can be complicated when they occur near the eyelids or especially on the cornea. Due to type I hypersensitivity response, such as epithelial defect, corneal edema, loss of endothelial cells, anterior uveitis, optic neuritis and, therefore, permanent loss of vision due to anterior segment ischemia. It warns that the wasp stinger has a saw-shaped texture, contains toxins that inflame the area where it stings. Due to the immunological and toxic effects of the stinger and its venom infiltrates the cornea. We present the case of a 32-year-old man who presented keratouveitis secondary to a wasp sting in a region of the jungle of Peru. He was treated emergency with intensive steroid therapy to reduce the toxic effects. His follow-up up to 2 months was successful, leaving only a 1 mm central leukoma where the bite occurred, which did not impair his vision.

A Case of Conjunctival Bee Sting Injury with Review of the Literature on Ocular Bee Stings

BACKGROUND Ocular bee stings have been rarely described in the literature, and their management is controversial. A case of conjunctival bee sting with retention of the stinger for 48 hours is presented with a review of the literature on the complications and management of ocular bee sting injury. CASE REPORT A 22-year-old beekeeper presented to the Emergency Department with mild symptoms from a conjunctival bee sting that he had received 48 hours previously. The stinger was removed in the Emergency Department, and topical antibiotic and anti-inflammatory treatment with corticosteroid were given. There were no complications in this case. However, review of the literature has shown that although the outcome from ocular bee stings can be mild, as in this case, ocular bee stings can result in severe visual symptoms that require amniotic membrane transplant (AMT). Management commonly includes removal of the stinger and both topical and systemic treatment with corticosteroids. The main complications include cataracts, inflammation of the anterior chamber, optic neuropathies, and changes in ocular pressure. CONCLUSIONS Ocular bee stings have been rarely described in the literature, and the management remains controversial. As this case has shown, removal of the stinger and the use of topical treatment with antibiotics and corticosteroids can prevent potentially serious complications that may affect vision. Early and regular follow-up with ocular imaging may be required when symptoms persist.

Management of Corneal Bee Sting Injuries

PURPOSE

To review the management of keratitis after corneal bee stings and to report a case of deep stromal corneal infiltrate secondary to a retained bee stinger managed conservatively in a patient who presented three days after unsanitary manipulation of the stinger apparatus.

METHODS

Case report and review of literature.

RESULTS

A 57-year-old male beekeeper was evaluated for pain, blurry vision, and photosensitivity after a corneal bee sting. Of note, the venom sac had been removed with dirty tweezers three days prior to his visit. On exam, a focal infiltrate with diffuse edema was seen surrounding a retained bee stinger in the peripheral cornea. Trace cells in the anterior chamber were also noted. Based on a high suspicion for infectious keratitis, a conservative treatment strategy was elected. Administration of broad-spectrum topical antibiotics with concomitant abstention of corticosteroids led to rapid resolution of the symptoms. Over 16 months of follow-up, the stinger has remained in situ without migration and the patient has maintained 20/20 visual acuity without complications. There is debate on the preferred method for the management of corneal injury secondary to bee stings, especially when it is associated with a retained stinger. We herein present our findings in our appraisal of reported cases.

CONCLUSION

In the aftermath of an ocular bee sting, close surveillance for inflammation and infection is essential. Individual manifestations of these injuries vary in timing, type, and severity; therefore, the accessibility of the stinger and the evolving clinical picture should guide therapeutic decisions.

A Case Series of Bee Sting Keratopathy With Different Outcomes in Malaysia

We report three patients with corneal bee sting at our tertiary care center in a three-year period starting from 2014 to 2016. All patients sustained a bee sting injury to the cornea. All patients received early preoperative topical antibiotics, topical cycloplegic and intensive topical steroids. However, the timing of the initial presentation, the duration, and the location of the retained stinger differed in each case leading to different postsurgical outcomes.

Bee sting of the cornea: A running case report

Bee stings that present with ocular sequelae are infrequently reported in the literature. The present report is of a retained corneal bee stinger with a delayed presentation. A review of case reports reveals a number of potential ocular complications of bee stings. The ocular sequelae and treatment options are reviewed.

The role of in vivo confocal microscopy in the diagnosis of hidden corneal foreign bodies

OBJECTIVE

To investigate in vivo confocal microscopy (IVCM) to diagnose hidden corneal foreign bodies.

METHODS

Male Kunming mice (n = 25; 12 weeks old) were anaesthetized prior to the insertion of five different materials (spiny wood, rusty iron, sharp stone, sharp glass fragment and human hair fragment) into the cornea by different traumatic processes. A separate mouse was used for each corneal foreign body. The corneas of the mice were scanned 24 h later by a laser scanning IVCM to establish the characteristics (shape, reflectivity and depth in the cornea) of each foreign body. These findings were used to help screen and identify corneal foreign bodies in patients. Corneal smears and scraping cultures were performed in cases of probable corneal infection.

RESULTS

Animal models for the five different foreign particles were established successfully, with each showing distinctive characteristics. These animal results were used to diagnose 41 patients with suspected corneal foreign bodies who were negative by slit lamp examination, but positive by IVCM (observational case series). The most prevalent type of hidden foreign body was plant material (51.2%), followed by metal (29.3%). Ten patients with corneal foreign bodies developed fungal keratitis, found using IVCM.

CONCLUSIONS

Laser IVCM is an effective and reliable tool for the diagnosis of hidden corneal foreign bodies.

Corneal honey bee sting: endoilluminator-assisted removal of retained stinger

To report the clinical findings and a novel method of removal of bee sting using an endoillumination light source the following methods were used: clinical presentation, slit-lamp photographs, serial endothelial images and surgical management of a case of retained bee sting in the cornea. The bee sting was surgically removed by forceps under focal illumination with an endoillumination light source. Topical steroids and cycloplegics were given postoperatively to control the inflammation. The patient had complete visual recovery and partial resolution of endothelial changes after 1 year of treatment. The clinical picture of a corneal honey bee sting resembles keratouveitis. Focal corneal infiltrate and associated low-grade uveitis tend to persist if treated with topical steroids only. Early recognition and prompt removal of the stinger may help in the early resolution of anterior segment inflammation and prevent irreversible damage to endothelial cells.

Management of corneal bee sting

Corneal bee sting is an uncommon environmental eye injury that can result in various ocular complications with an etiology of penetrating, immunologic, and toxic effects of the stinger and its injected venom. In this study we present our experience in the management of a middle-aged male with a right-sided deep corneal bee sting. On arrival, the patient was complaining of severe pain, blurry vision with acuity of 160/200, and tearing, which he had experienced soon after the injury. Firstly, we administered conventional drugs for eye injuries, including topical antibiotic, corticosteroid, and cycloplegic agents. After 2 days, corneal stromal infiltration and edema developed around the site of the sting, and visual acuity decreased to 100/200. These conditions led us to remove the stinger surgically. Within 25 days of follow-up, the corneal infiltration decreased gradually, and visual acuity improved to 180/200. We suggest a two-stage management approach for cases of corneal sting. For the first stage, if the stinger is readily accessible or primary dramatic reactions, including infiltration, especially on the visual axis, exist, manual or surgical removal would be indicated. Otherwise, we recommend conventional treatments for eye injuries. Given this situation, patients should be closely monitored for detection of any worsening. If the condition does not resolve or even deteriorates, for the second stage, surgical removal of the stinger under local or generalized anesthesia is indicated.

Prognosis of corneal wasp sting: case report and review of the literature

OBJECTIVES

To report the ocular complications associated with corneal wasp sting and to highlight the importance of eye protection in case of wasp offense.

METHODS

This was a retrospective, observational chart review.

RESULTS

A 34-year-old man was referred for severely decreased vision after being stung by a swap to the left cornea. Ophthalmologic examination showed a large corneal epithelial defect, anterior uveitis, and a left relative afferent pupillary defect. Vision was light perception. After treatment with cycloplegic, topical antibiotic, and systemic steroids for 2 weeks, the epithelial defect healed and anterior uveitis subsided; however, bulbous keratopathy and traumatic cataract developed. The visual acuity remained light perception with poor light projections. Twenty additional cases of corneal hymenoptera sting were reviewed from the English language literature, which shared certain characteristics including anterior uveitis, intractable glaucoma, traumatic cataract, toxic optic neuropathy, corneal scarring, and a catastrophic prognosis.

CONCLUSIONS

Wasp stings of the cornea may bring disastrous ocular damages. Outdoor works should manage to protect your eyes when confronted with a hymenoptera attack.

Corneal bee sting misdiagnosed as viral keratitis

PURPOSE

To report a case of chronic keratouveitis caused by a missed bee sting injury.

METHODS

A 17-year-old boy was referred for management of unresponsive viral keratouveitis. Ocular examination revealed corneal edema and scarring, atrophic patches on the iris, and anterior polar cataracts. Surprisingly, examination also revealed a retained intracorneal bee stinger. A retrospective inquiry confirmed a bee sting injury 2 years ago.

RESULTS

The patient was started on medical treatment and underwent operative removal of the bee stinger. Postsurgery, visual acuity improved, and the corneal edema regressed over a 1-month follow-up.

CONCLUSIONS

In cases of chronic keratouveitis, a meticulous examination is mandatory to rule out unusual causes like a retained corneal bee stinger. A retained intracorneal bee stinger may result in long-term corneal inflammation, which may not be controlled adequately with topical steroids. It should be removed, irrespective of the duration since the injury.

Corneal Bee Sting-Induced Endothelial Changes

PURPOSE

To report the acute management and clinical findings of a case of corneal bee sting and to report the outcome of corneal endothelial cell analysis 1 year after trauma.

METHODS

Clinical findings, anterior segment photographs, corneal endothelial images, and medical treatment of a case of right corneal bee sting are presented. Right and left central corneal endothelial cell analysis was performed by noncontact specular microscopy.

RESULTS

The stinger was removed from the cornea. Systemic, subconjunctival, and topical steroids and systemic and topical antibiotics were given. One year later, a corneal scar and anterior capsular opacity of the lens in the right eye were shown by slit-lamp examination. Endothelial cell analysis determined that the endothelial cell density of the right eye was substantially decreased compared with the left eye.

CONCLUSION

Corneal infiltration gradually decreased, presumably because of the systemic, topical, and subconjunctival steroids. Late complications observed in this case included a substantial decrease in cornea endothelial cell density, a corneal scar, and anterior capsular opacity.

Polymerase Chain Reaction Identification of a Hymenopteran Insect in the Cornea: a Case Report

The type of corneal injuries associated with insect encounters is related to the composition of the foreign body. However, previous reports on corneal foreign bodies as insects were rarely based on scientific evidence. Here, we report on a 49-year-old male who was stung in his left eye by an unknown insect. Emergent keratotomy was performed to remove the embedded corneal foreign body. The removed foreign body was observed under light microscopy, and a fragment of insect was suspected. The sample was sent for molecular analysis. The polymerase chain reaction product was sequenced, subjected to a BLAST search, and identified as an ichneumonoid member of the insect order Hymenoptera.

Corneal honeybee sting

BACKGROUND

We report the complications and management of a retained bee sting injury to the cornea. The case highlights the acute and chronic management of an uncommon injury and its pathogenesis.

METHODS

A 67-year-old man was attacked by a swarm of bees and was referred for severe chemosis on the right eye. A retained corneal bee stinger (ovipositor) was seen but removal was only partially successful. He subsequently developed a large corneal epithelial defect, anterior uveitis, intractable glaucoma, traumatic cataract, toxic optic neuropathy, and corneal scarring. We reviewed the literature on corneal bee sting injuries and their complications.

RESULTS

Inflammation was controlled with topical steroids and the patient underwent a combined phacoemulsification and trabeculectomy with mitomycin-C for uncontrolled glaucoma. However, optic neuropathy did not resolve.

INTERPRETATION

Corneal bee sting injuries are uncommon but can result in severe sight-threatening complications such as toxic optic neuropathy. Early recognition of the possible complications and appropriate treatment may help to prevent permanent loss of vision. Removal of a retained corneal bee stinger remains controversial.