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Bhargava M, Bhambhani V, Sen A, Johri A. Corneal foreign body post laser in-situ keratomileusis: Diagnosis, management, outcome and review of literature. Am J Ophthalmol Case Rep 2024; 34:102038. [PMID: 38532848 PMCID: PMC10963190 DOI: 10.1016/j.ajoc.2024.102038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/17/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose To report a case of metallic corneal foreign-body (CFB) penetrating the Laser in situ keratomileusis (LASIK) flap and its successful outcome. To highlight usefulness of Anterior Segment Optical Coherence Tomography (ASOCT) in diagnosis and management of post-LASIK CFB. To enumerate other similar cases published in literature. Method A 30-year-old male presented to the emergency department of a tertiary eye care centre with a metallic CFB. He had undergone uneventful LASIK elsewhere 4-years back. He was unaware of any trauma. CFB removal was attempted elsewhere but abandoned as CFB appeared deeply embedded. ASOCT showed CFB had penetrated LASIK flap and lodged into midstroma, 207 μm deep. CFB was successfully removed in operation theatre along with the application of cyanoacrylate glue and bandage contact lens. A review of literature for CFB in post-LASIK patients was done through PubMed search. Result Postoperative course was uncomplicated and there was a follow up period of 4 months. Vision improved to unaided 20/20 and N/6 from preoperative 20/60 and N/10. Review of literature of 24 patients showed Post-LASIK FB was more common in males (79%). None of the patients except for one had protective eye-wear. Metallic FB was most common followed by organic FB. Flap complications were present in seven patients. Diffuse lamellar keratitis (DLK) and epithelial ingrowth were the most common post-FB removal complications occurring in six (25%) and four (16.6%) patients respectively. Conclusion Post-LASIK patients with CFB need to be inspected for flap related complications. CFB can be successfully removed, although DLK, epithelial ingrowth, microbial keratitis, astigmatism, can occur post-CFB removal. ASOCT can delineate CFB and flap related details and thus is an additional useful imaging tool in such scenarios.
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Affiliation(s)
- Mona Bhargava
- Department of Cornea, Aditya Birla Sankara Nethralaya, 147/1 E M Bypass Road, Kolkata, 700099, India
| | - Varsha Bhambhani
- Department of Cornea, Aditya Birla Sankara Nethralaya, 147/1 E M Bypass Road, Kolkata, 700099, India
| | - Ahana Sen
- Aditya Birla Sankara Nethralaya, 147/1 E M Bypass Road, Kolkata, 700099, India
| | - Aditi Johri
- Department of Cornea, Aditya Birla Sankara Nethralaya, 147/1 E M Bypass Road, Kolkata, 700099, India
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2
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Jayaraj S, Samanta R, Agrawal A, Shrestha S. Multimodal imaging and management of multiple retained corneal bee stingers. BMJ Case Rep 2023; 16:e255939. [PMID: 37336628 PMCID: PMC10314465 DOI: 10.1136/bcr-2023-255939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Affiliation(s)
- Sreeram Jayaraj
- Ophthalmology, All India Institute of Medical Sciences - Rishikesh, Dehradun, Uttarakhand, India
| | - Ramanuj Samanta
- Ophthalmology, All India Institute of Medical Sciences - Rishikesh, Dehradun, Uttarakhand, India
| | - Ajai Agrawal
- Ophthalmology, All India Institute of Medical Sciences - Rishikesh, Dehradun, Uttarakhand, India
| | - Sandhya Shrestha
- Ophthalmology, All India Institute of Medical Sciences - Rishikesh, Dehradun, Uttarakhand, India
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3
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Huseynov M, Cebisli A, Ozturk A, Sahin M, Akin Ozdemir M, Polat M. Pediatric Penile Bee Sting. Pediatr Emerg Care 2022; 38:e1469-e1471. [PMID: 35904958 DOI: 10.1097/pec.0000000000002791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this study, for the first time in the literature, are to evaluate the symptoms, clinical course, and treatment management of penile bee stings in children and to discuss whether bee stings can be evaluated within the scope of summer penile syndrome. METHODS Records of all pediatric patients presented to the emergency department of our hospital from June 2020 to October 2021 due to bee sting of penis were reviewed. Only patients with isolated penile bee stings were included in the study. Patients were evaluated in terms of the age at presentation, time of occurrence, symptoms, and treatment modality. RESULTS There were 10 patients treated for penile bee sting. Patients ranged in age from 3 to 7 years (mean, 4.2 years). The most common complaints of the patients at presentation were pain (100%), swelling (100%), and dysuria (70%). Three of the patients were unable to void. The gauze moistened with warm saline was applied to the penis of these patients who developed glob, and all of these patients urinated after the warm application. Three of the patients had progressive erythema on the penile skin. These patients were admitted to the pediatric surgery department to monitor whether skin necrosis would develop. In all patients, the erythema regressed significantly within 48 hours and regained its completely normal appearance at the end of 72 hours. CONCLUSIONS The probability of the development of serious local reactions and urological problems in penile bee stings is low. Oral nonsteroidal anti-inflammatory drug and warm, wet dressing are usually sufficient to treat local reactions. Penile bee stings may be evaluated within the scope of summer penile syndrome because their symptoms, clinical findings, and treatments are almost similar.
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Affiliation(s)
| | - Ali Cebisli
- Emergency Medicine, Ercis Sehit Ridvan Cevik Public Hospital, Van, Turkey
| | - Atiye Ozturk
- Emergency Medicine, Ercis Sehit Ridvan Cevik Public Hospital, Van, Turkey
| | - Mahmut Sahin
- Emergency Medicine, Ercis Sehit Ridvan Cevik Public Hospital, Van, Turkey
| | - Merve Akin Ozdemir
- Emergency Medicine, Ercis Sehit Ridvan Cevik Public Hospital, Van, Turkey
| | - Mustafa Polat
- Emergency Medicine, Ercis Sehit Ridvan Cevik Public Hospital, Van, Turkey
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4
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Wang Y, Kang H, Jin M, Wang G, Ma W, Liu Z, Xue Y, Li C. Phenotypic and Transcriptomics Analyses Reveal Underlying Mechanisms in a Mouse Model of Corneal Bee Sting. Toxins (Basel) 2022; 14:toxins14070468. [PMID: 35878206 PMCID: PMC9323056 DOI: 10.3390/toxins14070468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Corneal bee sting (CBS) is one of the most common ocular traumas and can lead to blindness. The ophthalmic manifestations are caused by direct mechanical effects of bee stings, toxic effects, and host immune responses to bee venom (BV); however, the underlying pathogenesis remains unclear. Clinically, topical steroids and antibiotics are routinely used to treat CBS patients but the specific drug targets are unknown; therefore, it is imperative to study the pathological characteristics, injury mechanisms, and therapeutic targets involved in CBS. In the present study, a CBS injury model was successfully established by injecting BV into the corneal stroma of healthy C57BL/6 mice. F-actin staining revealed corneal endothelial cell damage, decreased density, skeletal disorder, and thickened corneal stromal. The terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) assay showed apoptosis of both epithelial and endothelial cells. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that cytokine–cytokine interactions were the most relevant pathway for pathogenesis. Protein–protein interaction (PPI) network analysis showed that IL-1, TNF, and IL-6 were the most relevant nodes. RNA-seq after the application of Tobradex® (0.3% tobramycin and 0.1% dexamethasone) eye ointment showed that Tobradex® not only downregulated relevant inflammatory factors but also reduced corneal pain as well as promoted nerve regeneration by repairing axons. Here, a stable and reliable model of CBS injury was successfully established for the first time, and the pathogenesis of CBS and the therapeutic targets of Tobradex® are discussed. These hub genes are expected to be biomarkers and therapeutic targets for the diagnosis and treatment of CBS.
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Affiliation(s)
- Yanzi Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Honghua Kang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Mengyi Jin
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Guoliang Wang
- School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China;
| | - Weifang Ma
- Department of Ophthalmology, No.4 West China Teaching Hospital, Sichuan University, Chengdu 610041, China;
| | - Zhen Liu
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
| | - Yuhua Xue
- School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China;
- Correspondence: (Y.X.); (C.L.); Tel./Fax: +86-592-2189698 (Y.X.)
| | - Cheng Li
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
- Correspondence: (Y.X.); (C.L.); Tel./Fax: +86-592-2189698 (Y.X.)
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5
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Duff- Lynes SM, Martin P, Horn EP. Management of bulbar conjunctival injury by honeybee sting: A case report of a retained honeybee stinger. Am J Ophthalmol Case Rep 2022; 25:101365. [PMID: 35128174 PMCID: PMC8810353 DOI: 10.1016/j.ajoc.2022.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/27/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To report a rare case of a bee sting to the conjunctiva of the eye in which the stinger remains in the subconjunctival space. OBSERVATIONS We present the case of a fifty-five-year-old male who sustained a honeybee sting to the conjunctiva of his left eye after which some stinger remnants were left in place. He was initially treated with topical antibiotics, and topical and systemic steroids were added the next day. His visual acuity recovered fully with this regimen, despite later visualization of a retained bee stinger in the subconjunctival space. CONCLUSION AND IMPORTANCE Our experience suggests that though immediate removal of a stinger in the case of a bee sting to the eye is likely the safest approach, the long-term persistence of a bee stinger in the conjunctiva may not pose a threat to visual acuity and ocular health.
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Affiliation(s)
| | - Pamela Martin
- University of Florida, Ophthalmology Department, 1600 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Erich P. Horn
- Department of Ophthalmology, Malcolm Randall Department of Veterans Affairs Medical Center, Gainesville, FL, USA
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6
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Su Z, Hu Z, Wang L, Wang Y, Fang X, Ye P. Visual Loss Caused by Central Retinal Artery Occlusion After Bee Sting: A Case Report. Front Med (Lausanne) 2021; 8:707978. [PMID: 34881252 PMCID: PMC8645682 DOI: 10.3389/fmed.2021.707978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
A bee sting can lead to an extremely rare case of visual loss caused by central retinal artery occlusion (CRAO). In this study, we report a 66-year-old healthy woman who was referred to our Eye Center because of visual loss, which had occurred after bee sting 2 days earlier. The visual acuity was no light perception (NLP). Examination revealed left eyelid edema, conjunctiva congestion, a 6-mm fixed pupil, scattered retinal hemorrhage, and white-appearing ischemic retina with one small area of the normal-appearing retina temporal to the optic disk. Fundus fluorescein angiography revealed CRAO with one cilioretinal artery sparing. Her systemic workup revealed hypersensitivity, hypercoagulable state, myocardial damage, and hepatic damage. After topical and systemic treatments, the visual acuity was still NLP with improved systemic workup. In brief, CRAO may occur after bee sting, and visual acuity should be monitored for early diagnosis.
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Affiliation(s)
- Zhitao Su
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhongli Hu
- Department of Ophthalmology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Lei Wang
- Department of Emergency, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Wang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyun Fang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Panpan Ye
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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7
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Wang G, An X, Zhou X, Jin M, Wang X, Zong R, Liu Z, Liu Z, Xue Y, Li C. Real-time confocal microscopy imaging of corneal cytoarchitectural changes induced by different stresses. Exp Eye Res 2021; 210:108706. [PMID: 34324861 DOI: 10.1016/j.exer.2021.108706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
Maintenance of the corneal refractive power and tissue transparency is essential for normal vision. Real-time characterization of changes in corneal cells during suffering stresses or wound healing may provide a way to identify novel targets, whose therapeutic manipulation can improve the outcome of this response induced by injury. Here we describe a novel user friendly and effective confocal real-time confocal microscopy attachment that monitors the effects of anisoosmotic stress on cell morphology and corneal thickness in situ. Corneal epithelial nuclei gradually became highly reflective in the isotonic group and the corneal stroma was slightly thickened as compared with that seen prior to 60 min exposure to a hypotonic solution. After 30 min of exposure to hypertonic stress, the corneal stromal cells became crenate and shriveled. The hyper-reflective area of the corneal stroma in the hypo-osmotic group was significantly larger than that in the other two groups, as demonstrated by 3D reconstruction imaging. The hypotonic fresh chlorinated pool water was observed to cause atrophy of corneal epithelial nuclei, while the isosmotic bee venom solution caused high reflection of the corneal stroma layer and corneal endothelial cell damage. With the microscopic attachment, the inward movement of corneal epithelial cells toward the denuded central region was detected in the serum-treated group. The microscopy attachment is an effective system for obtaining a more detailed understanding of the time dependent losses in the corneal cell structure and tissue architecture of full thickness corneas induced by osmotic stress or cytotoxic agents.
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Affiliation(s)
- Guoliang Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Xiaoya An
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China
| | - Xiaoping Zhou
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China
| | - Mengyi Jin
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Xuemei Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Rongrong Zong
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Zhen Liu
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Zuguo Liu
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Yuhua Xue
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China.
| | - Cheng Li
- Eye Institute & Affiliated Xiamen Eye Center, School of Pharmaceutical Sciences & School of Medicine, Xiamen University, Xiamen, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China.
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8
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Tyagi M, Reddy S, Basu S, Pappuru RR, Dave VP. Endoscopic visualization-assisted corneal bee sting removal. Indian J Ophthalmol 2021; 69:423-425. [PMID: 33463602 PMCID: PMC7933875 DOI: 10.4103/ijo.ijo_1161_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: Deeply embedded corneal foreign bodies and intrastromal foreign body removal can often be a challenge. The aim of this report was to describe the utility of endoscopy in visualization and removal of an embedded corneal bee stinger. Methods: A 44-year-old male patient developed toxic keratopathy after injury from a bee stinger. On examination, the bee stinger was noted to be deeply embedded in the corneal stroma. A superficial keratectomy was initially attempted; however, the stinger was noted to be intrastromal and protruding into the anterior chamber and could not be removed. An Endoscopy-assisted visualization was used to remove the stinger. Results: The bee stinger was successfully removed and the patient's vision improved to 20/100 from an initial CFCF (counting fingers close to face) at time of presentation. At the end of 3 months follow-up, there was residual corneal edema along with cataractous changes in the lens as a sequelae of the initial bee sting injury. The patient subsequently underwent an endothelial keratoplasty along with phacoemulsification with intraocular lens implantation and the final BCVA improved to 20/40. Conclusion: Endoscopyassisted visualisation of anterior chamber and angle structures can be valuable in removal of retained and deeply embedded corneal or intracameral foreign bodies.
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Affiliation(s)
- Mudit Tyagi
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Subhakar Reddy
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajeev R Pappuru
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek P Dave
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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9
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Mouinga Abayi DA, Mvé Mengome E. [Ocular bee sting: A case report]. J Fr Ophtalmol 2021; 44:e191-e193. [PMID: 33446350 DOI: 10.1016/j.jfo.2020.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/26/2020] [Indexed: 10/22/2022]
Affiliation(s)
- D A Mouinga Abayi
- Service d'ophtalmologie de l'hôpital d'instruction des Armées Omar Bongo Ondimba, BP 20404, Libreville, Gabon.
| | - E Mvé Mengome
- Service d'ophtalmologie de l'hôpital d'instruction des Armées Omar Bongo Ondimba, BP 20404, Libreville, Gabon
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10
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González AL, Silva F, Barrientos R. Management of Secondary Keratouveitis in a Wasp Sting Patient in a Jungle Region of Peru. Int Med Case Rep J 2020; 13:663-666. [PMID: 33244277 PMCID: PMC7685374 DOI: 10.2147/imcrj.s284184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Ana Luisa González
- Department of Ophthalmology, Research Department Clinica La Luz, Lima, Peru
| | - Fermin Silva
- Department of Ophthalmology, Research Department Clinica La Luz, Lima, Peru
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11
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Dulaurent T, Perard B, Mathieson I, Dulaurent AM, Isard PF. Corneal bee sting in a Bengal cat. JFMS Open Rep 2020; 6:2055116920962431. [PMID: 33194217 PMCID: PMC7605039 DOI: 10.1177/2055116920962431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 6-month-old female Bengal cat was referred for a suspected vegetal foreign body (FB) in the mid-stroma of the right cornea. A small dark linear FB was identified in the dorsal aspect of the cornea, with associated cell infiltrate. Ophthalmic examination was otherwise normal, with no inflammatory reaction of the anterior uvea, and no abnormalities of the lens or fundus. Surgical removal was performed under general anesthesia. The FB, as observed under an optic microscope, was a worker bee stinger without the venom sac. Medical treatment consisted of topical and systemic antibiotics and steroids, and topical administration of atropine. Follow-up was uneventful. Relevance and novel information Ocular bee stings have been described in humans, with several consequences ranging from mild conjunctivitis to severe lesions affecting the cornea, iris, lens and retina. Most severely affected cases have been observed when the venom sac was found with the stinger, with a likely greater amount of venom being delivered into the ocular structures. The relatively benign presentation of this case was probably due to the lack of the venom sac within the bee sting. To our knowledge, this is the first documented case of a corneal bee sting in a cat.
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Affiliation(s)
- Thomas Dulaurent
- Saint-Martin Hospital Veterinary Centre, Saint Martin Bellevue, France
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12
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Semler-Collery A, Hayek G, Ramadier S, Perone JM. A Case of Conjunctival Bee Sting Injury with Review of the Literature on Ocular Bee Stings. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1284-1289. [PMID: 31471535 PMCID: PMC6735618 DOI: 10.12659/ajcr.917592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/28/2019] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Axelle Semler-Collery
- Department of Ophthalmology, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz-Cedex, France
| | - George Hayek
- Department of Ophthalmology, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz-Cedex, France
| | - Sophie Ramadier
- Institut Paris Descartes, Sorbonne Paris Cité, University Imagine Institute, Paris, France
| | - Jean-Marc Perone
- Department of Ophthalmology, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz-Cedex, France
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13
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Höllhumer R. The bee sting and the eye: A case report of an ab-externo sting removal technique. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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14
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Lee CH, Lee CH, Chang MH, Seo YS. A Report of Two Case of Ocular Toxicity Resulting from Direct or Indirect Bee Venom. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chan Ho Lee
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Chang Hwan Lee
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Moo Hwan Chang
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Young Seung Seo
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
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Rouatbi A, Chebbi A, Bouguila H. Hymenoptera insect stings: Ocular manifestations and management. J Fr Ophtalmol 2018; 42:37-43. [PMID: 30559016 DOI: 10.1016/j.jfo.2018.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the ocular findings and management of Hymenoptera insect stings. METHODS We treated and followed 8 patients with ocular Hymenoptera stings. All patients were admitted through emergencies and hospitalized at the Hedi Rays eye institute in Tunis. RESULTS The site of the sting was the cornea in 5 cases, limbus in one case, conjunctiva in one case and upper lid in the last case. Retained stingers were objectified in 4 cases. Immediate surgical extraction carried out in all cases. We also followed one case of post-sting Adie's syndrome and one case of retrobulbar optic neuritis. The sting was conjunctival in one case and palpebral in the other case. Corticosteroids were ineffective in these two cases. CONCLUSION Ocular Hymenoptera stings are rare environmental accidents. They may cause various severe ocular complications. Early management, adapted to the clinical manifestations, is the key to a good outcome.
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Affiliation(s)
- A Rouatbi
- National institute of ophthalmology, faculty of medicine of Tunis (FMT), Tunisia university of Tunis El Manar, Tunis, Tunisia.
| | - A Chebbi
- National institute of ophthalmology, faculty of medicine of Tunis (FMT), Tunisia university of Tunis El Manar, Tunis, Tunisia
| | - H Bouguila
- National institute of ophthalmology, faculty of medicine of Tunis (FMT), Tunisia university of Tunis El Manar, Tunis, Tunisia
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Ramappa M, Dhakal R, Chaurasia S. Oval sign: A retained bee stinger. Indian J Ophthalmol 2018; 66:1466-1467. [PMID: 30249836 PMCID: PMC6173003 DOI: 10.4103/ijo.ijo_465_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Muralidhar Ramappa
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Roheet Dhakal
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sunita Chaurasia
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Gudiseva H, Uddaraju M, Pradhan S, Das M, Mascarenhas J, Srinivasan M, Prajna NV. Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes. Indian J Ophthalmol 2018; 66:262-268. [PMID: 29380771 PMCID: PMC5819108 DOI: 10.4103/ijo.ijo_600_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: The purpose of this study is to describe the presenting features, management strategies, and clinical outcome following bee sting injury to the cornea. Methods: Retrospective case series involving 11 eyes of 11 patients with corneal bee sting injuries who presented over a period of 2 years. Nine of these 11 eyes had the presence of intact bee stinger in the cornea, which was removed immediately under an operating microscope and sent for microbiological and histopathological evaluation. The patients were managed as per the individual treatment protocol of the respective treating physicians. Results: Six eyes (54.5%) had a good clinical outcome (best-corrected visual acuity [BCVA] >20/40) with medical therapy alone with no need for surgical intervention. Five eyes (45.5%) had a poor clinical outcome (BCVA <20/40) with medical therapy and required surgery; of which three required a combined penetrating keratoplasty with cataract surgery, while one required isolated cataract surgery and one underwent penetrating keratoplasty. Glaucoma was present in 3/5 eyes undergoing surgery, one of which required a trabeculectomy. Five of the six eyes who had a good clinical outcome with medical therapy alone had been treated with concomitant oral steroids, along with topical antibiotic-steroid combination therapy. Conclusion: Oral corticosteroid supplementation to the topical steroid antibiotic treatment in patients with corneal bee sting injury where corneal involvement and anterior reaction is severe at presentation or inflammation not ameliorating with topical steroids alone prevents serious vision-threatening complications such as corneal decompensation, cataract, and glaucoma.
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Affiliation(s)
- Hemalatha Gudiseva
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Madhu Uddaraju
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sayali Pradhan
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Manoranjan Das
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Jeena Mascarenhas
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - M Srinivasan
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - N Venkatesh Prajna
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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18
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Nowroozzadeh MH, Hamid A, Bolkheir A, Shirvani M, Maalhagh M. Corneal wasp sting: A case report and review of literature. J Curr Ophthalmol 2018; 31:95-97. [PMID: 30899854 PMCID: PMC6407084 DOI: 10.1016/j.joco.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/24/2018] [Accepted: 02/28/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To report severe immunologic and toxic reaction due to corneal wasp sting that may cause catastrophic sight-threatening outcomes. Methods A 45-year-old man referred to the emergency room with corneal wasp sting of Vespa Orientalis. The authors review previous Medline literature about this topic. Results In our case, the response to frequent topical corticosteroid was dramatic, and at the seventh day after injury, all inflammatory responses in the anterior segment of the eye had been resolved. Conclusion Corneal wasp injury with Vespa Orientalis can cause severe inflammation of the cornea and the anterior segment. Topical corticosteroids are the mainstay of treatment.
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Affiliation(s)
| | - Adel Hamid
- Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Bolkheir
- Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Shirvani
- Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnoosh Maalhagh
- Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Ophthalmology, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Ono T, Iida M, Mori Y, Nejima R, Iwasaki T, Amano S, Miyata K. Outcomes of bee sting injury: comparison of hornet and paper wasp. Jpn J Ophthalmol 2018; 62:221-225. [DOI: 10.1007/s10384-018-0563-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
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20
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Rai RR, Gonzalez-Gonzalez LA, Papakostas TD, Siracuse-Lee D, Dunphy R, Fanciullo L, Cakiner-Egilmez T, Daly MK. Management of Corneal Bee Sting Injuries. Semin Ophthalmol 2017; 32:177-181. [PMID: 26161915 DOI: 10.3109/08820538.2015.1045301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Ruju R Rai
- a Veterans Affairs Boston Healthcare System , Boston , MA , USA.,b Department of Ophthalmology , Boston University School of Medicine , Boston , MA , USA.,c Department of Ophthalmology , Harvard Medical School , Boston , MA , USA , and.,d Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - Luis A Gonzalez-Gonzalez
- a Veterans Affairs Boston Healthcare System , Boston , MA , USA.,c Department of Ophthalmology , Harvard Medical School , Boston , MA , USA , and.,d Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - Thanos D Papakostas
- a Veterans Affairs Boston Healthcare System , Boston , MA , USA.,c Department of Ophthalmology , Harvard Medical School , Boston , MA , USA , and.,d Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - Donna Siracuse-Lee
- a Veterans Affairs Boston Healthcare System , Boston , MA , USA.,b Department of Ophthalmology , Boston University School of Medicine , Boston , MA , USA
| | - Robert Dunphy
- a Veterans Affairs Boston Healthcare System , Boston , MA , USA
| | - Lisa Fanciullo
- a Veterans Affairs Boston Healthcare System , Boston , MA , USA
| | | | - Mary K Daly
- a Veterans Affairs Boston Healthcare System , Boston , MA , USA.,b Department of Ophthalmology , Boston University School of Medicine , Boston , MA , USA.,c Department of Ophthalmology , Harvard Medical School , Boston , MA , USA , and
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Ang WJ, Md Kadir SZ, Fadzillah AJ, Zunaina E. A Case Series of Bee Sting Keratopathy With Different Outcomes in Malaysia. Cureus 2017; 9:e1035. [PMID: 28357167 PMCID: PMC5356989 DOI: 10.7759/cureus.1035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Wen-Jeat Ang
- Department of Ophthalmology, Universiti Sains Malaysia
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22
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Kim HJ, Shin JH, Moon SW. Prognosis of Ocular Injury Caused by Wasp Sting: Case Reports. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.12.1981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hye-Jee Kim
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae-Ho Shin
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Woong Moon
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Yardley AME, Hoskin AK, Hanman K, Wan SL, Mackey DA. Animal-inflicted ocular and adnexal injuries in children: A systematic review. Surv Ophthalmol 2015; 60:536-46. [PMID: 26022273 DOI: 10.1016/j.survophthal.2015.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022]
Abstract
Eye injury remains the leading cause of monocular blindness in children despite 90% of injuries being potentially preventable. Children interact with animals in a variety of situations, and the associated dangers may be underestimated. Animals are capable of causing ocular and adnexal injuries that are cosmetically and visually devastating. We examine the current literature regarding the nature and severity of animal-inflicted ocular and adnexal injuries in children.
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Affiliation(s)
- Anne-Marie E Yardley
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Lions Eye Institute, Perth, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia.
| | - Annette K Hoskin
- Lions Eye Institute, Perth, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Kate Hanman
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Lions Eye Institute, Perth, Western Australia, Australia
| | - Sue L Wan
- Lions Eye Institute, Perth, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - David A Mackey
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Lions Eye Institute, Perth, Western Australia, Australia
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Höllhumer R, Carmichael TR. Bee sting of the cornea: A running case report. AFRICAN VISION AND EYE HEALTH 2015. [DOI: 10.4102/aveh.v74i1.288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
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.
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Corneal bee sting controlled with early surgical intervention and systemic high-dose steroid therapy. Case Rep Ophthalmol Med 2015; 2014:140626. [PMID: 25580326 PMCID: PMC4280807 DOI: 10.1155/2014/140626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 12/06/2014] [Indexed: 11/22/2022] Open
Abstract
A 34-year-old Asian woman presented with painful corneal bee sting. Examinations revealed severe corneal swelling with stinger stuck in deep stroma and endothelial cell loss. She was treated with early surgery including stinger removal and anterior chamber irrigation combined with systemic high-dose steroid therapy. Vision and corneal clarity was recovered in 5 days and no additional corneal endothelial damage was observed. This report suggests that early surgical intervention and high-dose steroid therapy appear to be a useful option in the treatment of corneal bee sting.
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26
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Isawumi MA, Hassan MB. Honeybee sting of the sclera: occular features, treatment, outcome and presumed pathogenesis. Pan Afr Med J 2014; 17:30. [PMID: 24932341 PMCID: PMC4048680 DOI: 10.11604/pamj.2014.17.30.3297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/22/2013] [Indexed: 11/18/2022] Open
Abstract
Ocular bee sting injury has caused several reactions in the eye but has rarely been reported among local African farmers, and Nigerians in particular. This case seeks to report the first ocular and external eye reactions following a honey bee sting of the eye through the sclera, highlighting the treatment and outcome. Oral interview, clinical examination and external photographs were used to obtain and document findings. Medical treatment was instituted as soon as subject presented. There was complete inflammatory resolution within a week, normal vision and no evidence of stinger migration after four weeks of follow up. The wound site healed with ciliary staphyloma. The role of physical properties, immunological and genetics interplay and the presumed pathogenesis is further discussed. Health education on early presentation and avoidance of harmful traditional eye medications should be promoted among the farming populations in our communities, in order to prevent blinding complications
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Xu Z, Yu X, Li Z, Wang L. The role of in vivo confocal microscopy in the diagnosis of hidden corneal foreign bodies. J Int Med Res 2013; 42:145-52. [PMID: 24304926 DOI: 10.1177/0300060513505957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Zhongzhong Xu
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Li Z, Oh HJ, Ji Y, Yoon KC. Wasp sting of the cornea: A case treated with amniotic membrane transplantation. Graefes Arch Clin Exp Ophthalmol 2012; 251:1039-40. [DOI: 10.1007/s00417-012-2072-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/22/2012] [Indexed: 10/28/2022] Open
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Abstract
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.
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Affiliation(s)
- Hassan Razmjoo
- Medical School, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran
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