If so, could a barbed bee stinger become lodged into the eye? And most troubling, would blindness result from a sting to the eye? When an eyeball sustains an insect sting, the eye itself will swell. If the cornea is stung, immediate and severe inflammation and tissue degradation will result, and the pain is reported as being excruciating. Glaucoma and atrophy of the iris can occur, which often leads to some degree of eyesight loss. The ophthalmologist removed the stinger.
The patient made a full recovery after treatment with antibiotics and steroids. Farrah Balboul had a less dramatic encounter with a bee sting recently. She was walking her dog when she was stung near the eye.
I experienced blurry vision for a while, but it eventually went away. I was lucky — my vision went back to normal. About Foundation Museum of the Eye. In such cases, not only is a venomous reaction possible, but also the disembodied stinger may damage the corneal surface. Direct stings to the ocular surface, including the cornea or conjunctiva, occur less commonly, but are far more serious.
When the cornea is directly involved, patients experience a greater degree of pain and a focal inflammatory reaction will be noted at the site of inoculation.
Initially, this may be seen as localized, disciform edema, but tissue degradation will occur as the toxins impact the cellular structure. White cell infiltration is often noted within an hour of the injury, and an anterior chamber response is also common. Biomicroscopically, a corneal sting injury may appear similar to a foreign body with infiltrate or even an infectious keratitis. In fact, if the stinger penetrates the cornea, a more severe, toxic uveitis can result.
Even more alarming, several cases of cataract formation secondary to wasp sting penetration through the anterior lens capsule have been documented. Other long-term changes include: bullous keratopathy; corneal neovascularization and opacification; persistent uveitis; iris atrophy; and secondary glaucoma.
Numerous cases of sting-induced optic neuritis have been reported, as well as retinal damage and ciliochoroidal detachment. Management Strategies Management strategies for bee and wasp stings vary based upon the location and extent of the injury.
For superficial wounds, first aid may be all that is required. Retained stingers in the skin of the lids or adnexa should be removed carefully and the area should be cleaned with soap and water or Betadine povidone-iodine, Alcon.
Cold compresses may be helpful in limiting the secondary inflammatory response. Ice wrapped in cloth to avoid freezing the skin should be applied for no more than 20 minutes every hour. Sting injuries involving the globe are more serious and warrant additional therapy.
If the conjunctiva is the inoculation site, medical treatment is limited to the ocular surface. Topical antibiotics and corticosteroids—either separate or in combination—represent the ideal therapy for preventing secondary bacterial infection and curtailing associated inflammation.
Be sure to treat corneal injuries in a similar fashion. Broad-spectrum antibacterial agents, such as gentamicin or a fluoroquinolone, have been advocated. In addition, more frequent administration of potent steroids e.
Cycloplegia with a strong agent, such as scopolamine or atropine, is likewise recommended. Treating uveitis aggressively and proactively will help prevent long-term sequelae, including cataracts, iris atrophy and glaucoma.
For patients with toxic optic neuritis associated with envenomation, early intervention with pulsed steroids may prevent permanent visual loss.
A three-day course of intravenous methylprednisone followed by a tapered dose of oral prednisone over seven additional days has been shown to help patients recover visual function following this type of trauma. While ocular sting injuries are not a common occurrence, primary eye care providers must be ready for any scenario. Recognition, careful evaluation and prompt intervention in these cases can help prevent or reverse significant visual impairment.
Kabat and Sowka are paid consultants for Alcon Laboratories.
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