Successful treatment of corneal wasp sting-induced panuveitis with vitrectomy

Endothelial dysfunction of the cornea after exposure to sprayed venom from hornets

PURPOSE

Ocular injuries due to Hymenoptera venom are uncommon and most injuries occur on the ocular surface. We reported two rare cases of corneal endothelial damage caused by hornet venom that was sprayed, not injected, through stinging in the eye.

OBSERVATIONS

Case 1: A 57-year-old male patient was injured when a hornet sprayed venom into his left eye. He was referred to our hospital because the edoema and epithelial erosion of the cornea persisted. The patient presented with bullous keratopathy, asymmetrical iris atrophy, irreversible mydriasis, and glaucoma. His cataract progressed, and his best-corrected visual acuity was 0.03. Cataract surgery was performed after anti-inflammatory treatment with steroids, and Descemet-stripping automated endothelial keratoplasty was performed 6 months later. The patient recovered well postoperatively: his best-corrected visual acuity improved to 1.0 and he continued his glaucoma treatment. Case 2: A 75-year-old male patient had damage to his corneal epithelium, severe conjunctivitis, and conjunctival edoema when sprayed hornet venom entered his left eye. At initial presentation, the corneal endothelial cell density had decreased to 1042 cells/mm2. The conjunctival sac was washed, and steroid and topical antibacterial instillations were administered. His best-corrected visual acuity improved from 0.07 at the initial visit to 0.5. However, the corneal opacification and glaucoma persisted, and 3 months later the corneal endothelial cell density decreased to 846 cells/mm2.

CONCLUSIONS AND IMPORTANCE

Corneal injuries caused by sprayed hornet venom are rare; however, they can cause intense anterior chamber inflammation and severe, irreversible corneal endothelial damage. In such cases, prompt initial treatment, the administration of adequate anti-inflammatory medication, and careful evaluation of the corneal endothelium are required.

Bee sting presumed endophthalmitis: a devastating ocular outcome

BACKGROUND

To report a rare case of bee sting presumed endophthalmitis that resulted in a devastating ocular outcome.

CASE PRESENTATION

A 43-year-old patient presented 24 h after bee sting ocular injury in his left eye. He had a mild inflammatory sign at presentation, and he underwent surgical exploration to rule out a scleral defect, which revealed a sealed defect. During his hospital course, he developed signs of endophthalmitis 48 h following trauma for which he received vitreous tap and intravitreal antibiotic. Microbial culture revealed gram-negative rods, Pseudomonas aeruginosa, and Aeromonas veronii. Condition escalated to reach the panophthalmitis stage and cellulitis like picture with visual acuity of no light perception. Visual evoked response (VER) demonstrated a flat response. Infection was controlled by evisceration of the globe at the end as salvage therapy against the spreading of infection CONCLUSIONS: Bee sting ocular injury is an exceedingly rare type of ocular trauma. Concomitant infection can happen, and severity depends on the pathogen involved. It is crucial to have insight and start appropriate treatment based on to the patient presentation.

Endoscopic visualization-assisted corneal bee sting removal

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.

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.

Successful management of bee sting induced Aspergillus fumigatus endophthalmitis and scleritis

Ocular bee stings are known to cause corneal melts, corneal infiltrates, cataracts, and secondary glaucoma. Our patient presented with scleritis, corneal infiltrates, and endophthalmitis after a ocular bee sting. Topical treatment led to resolution of anterior segment inflammation, but the scleritis and vitreous inflammation worsened. Vitrectomy with intravitreal antibiotics was done and scrapings from the scleral abscess showed growth of Aspergillus fumigatus on culture. Repeat vitrectomy with silicone oil was needed for retinal detachment. Oral and intravitreal antifungals led to resolution of inflammation with attached retina. This is the first reported case of bee sting-induced fungal endophthalmitis with scleritis.

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.