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      Management of corneal bee sting

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          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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          Most cited references 12

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          Ocular lesions arising after stings by hymenopteran insects.

          To describe the ocular lesions that occur after stings from hymenopteran insects. We examined the ocular alterations in five patients who suffered ocular trauma from hymenopteran insect stings. In 4 cases where the insect was identified as a wasp, all the patients presented with persistent corneal decompensation and two presented with total cataract, requiring surgical treatment. In the case of trauma by a bee sting, the patient presented with corneal edema and an inflammatory reaction of the anterior chamber with total regression of these alterations after clinical treatment. Although a rare occurrence, ocular trauma caused by hymenopteran insects can result in severe ocular alterations in humans.
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            Bee sting of the cornea and conjunctiva: management and outcomes.

            To present the clinical features, management, and outcomes of 4 cases of bee sting injury to the cornea and conjunctiva. Clinical features, external photographs, treatment, and outcomes of 4 cases of ocular bee stings are presented. In 3 cases, the stinger of the bee was retained on the cornea, and in 1 case, it was retained on the conjunctiva. One of the 3 corneal sting patients was stung on the laser in situ keratomileusis flap margin, which resulted in a partial tear of the flap. Retained bee stings were removed immediately in all 4 cases, and topical antibiotics were applied with adjuvant treatment. All patients had good visual outcomes without severe complications at follow-up. Ocular surface bee stings with retained stingers are rarely reported. A potential triad of penetrating, immunologic, and toxic injury must be taken into consideration. Vision can be restored by early removal of the sting and topical medication.
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              Corneal bee sting-induced endothelial changes.

              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. 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. 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. 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.

                Author and article information

                Clin Ophthalmol
                Clinical Ophthalmology
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove Medical Press
                02 December 2011
                : 5
                : 1697-1700
                [1 ]Medical School, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran
                [2 ]Ophthalmology Ward, Feiz Hospital, IUMS, Isfahan, Iran
                [3 ]Isfahan Medical Students Research Center (IMSRC), IUMS, Isfahan, Iran
                [4 ]Isfahan Ophthalmology Research Center (IORC), Feiz Hospital, IUMS, Isfahan, Iran
                Author notes
                Correspondence: Seyed-Hossein Abtahi, S.H.A. Official Research Center of Neurological-Ophthalmological Sciences (SHARNOS Co), No 9, Boroomand, Seyed-Alikhan, Chaharbagh Abbasi, Isfahan 81448-14581, Iran, Tel +98 913 409 8036, Fax +98 311 264 3588, Email shf.abtahi@ 123456yahoo.com
                © 2011 Razmjoo et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Case Report

                Ophthalmology & Optometry

                bee sting, stinger, cornea, removal, management, surgery


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