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

Abstract

Patient: Male, 24Final Diagnosis: Bee sting conjunctival injurySymptoms: Eye pain • red eyeMedication: —Clinical Procedure: Ablation of the bee stingSpecialty: OphthalmologyObjective:Unusual clinical courseBackground: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.

Endoscopic visualization-assisted corneal bee sting removal

“…After Bee sting, the bee loses its stinger and part of its abdomen leading to eventual death of bee. [ 1 ] In general removal of bee stinger depends on associated severity of inflammation/infiltration at presentation, the proximity of the injury site to the visual axis, depth of stinger and its external accessibility. [ 5 ]…”

“…Corneal bee sting injuries can lead to various ocular manifestations including conjunctival injury with or without retained stings, toxic keratitis, bullous keratopathy, anterior uveitis, iris atrophy, glaucoma, cataract, lens subluxation, optic neuritis, and panuveitis. [ 1 2 3 4 5 6 ] Bee venom is also known to incite a local toxic or immunologic reaction on cornea. [ 7 8 ] Management of corneal bee sting injuries in general is to control inflammatory reaction and to prevent secondary infections with conservative approach of topical steroids, antibiotics, and cycloplegics.…”

Commentary

“…Corneal bee sting injuries are most commonly observed, with conjunctival, periocular tissue, and palpebral bee stings reported less frequently. [ 1 ]…”

“…Various factors affect the severity of presentation, including the depth of penetration of the stinger, toxicity of the bee-venom, and host-inflammatory response. [ 1 ]…”

“…[ 2 ] Anterior segment optical coherence tomography and confocal microscopy are useful adjuncts to determine the severity of the inflammatory response and the location as well as extent of bee stinger within the corneal stroma. [ 1 ]…”