|Year : 1982 | Volume
| Issue : 3 | Page : 151-153
Wasp sting of the cornea
P Pillai, DN Gangwar, IS Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Department of Ophthalmology, PGI Chandigarh, 160012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pillai P, Gangwar D N, Jain I S. Wasp sting of the cornea. Indian J Ophthalmol 1982;30:151-3
Wasp sting is an extremely rare form of ocular injury. Insects which have stings are bees, wasps, hornets, ants and scorpions. Reports in the literature describing such injuries have appeared, through quite rarely. The sting, which lies in the abdomen of the female insect has a piercing apparatus with poison glands. In the act of stinging this poison is discharged which causes in its victim, a local reaction ranging from moderately severe to intensely painful, with general systemic effects as well.
A 12 year old girl suffered the direct sting of a wasp on her right cornea. The ocular inflammation thus set-up is described, along with certain other interesting features.
| Case report|| |
A 12 years old girl, a resident of a town in Punjab, felt something suddenly strike her RE followed by sharp pain. A wasp, which had caused the injury, fell out. At a local hospital a wasp sting was removed from her cornea. Local treatment was also instituted. She presented to our OPD on after 6 weeks [Figure - 1]
Her visual acuity on the first day was 6/18 in the affected eye and 6/6 in the L.E. The site of injury was marked by an ulcerated area measuring 3.4 mm in diameter and located in the upper nasal quadrant of the cornea. Deep stromal haze surrounding this area and in the lower nasal part of the cornea, was observed. Endothelial changes and epithelial bedewing were also present. Iris pigment dusting of the posterior corneal surface was well marked. The sting has apparently not caused a through and through perforation of the cornea. The pupil was widely dilated and not reacting to light (initially presumed to be the effect of Atopine). The most striking feature was the depigmentation of the iris especially marked in the lower part. A small central star shaped cataract involving the capsule and anterior cortex was another feature. The fundus was normal. 1.0. tension (Schiotz) was also normal. She was put on local antibiotic drops.
On subsequent visits she showed remarkable improvement. The ulcerated area healed and much of the stromal haze cleared up After 6 weeks recorded vision was 6/9 with -} 0.75 Dcyl 90° in the affected eye. Gonioscopy revealed a highly pigmented trabecular mesh work and peripheral anterior synechiae Fluorescein angiography of the fundus did no reveal any abnormality.
On follow-up for a period of five months iris depigmentation was seen to become more pronounced, with atrophy of the pupillary frill and ectropion uvea. The other long tern effects observed were a persistently dilate pupil unresponsive to miotics and some degree, of keratopathy. Visual prognosis was however quite good as the star shaped cataract did no progress and secondary glaucoma did no supervene.
| Discussion|| |
Iris tissue seemed to be particularly susceptible to the toxic effects of wasp venom a; evidenced by the striking iris depigmentation the sphincteric atrophy and the persistent mydriasis. The cornea and lens were les; affected even though the brunt of the direct injury had seen on the cornea. Wasp venom is known to have a cholinesterase which may be partially responsible for the mydriasis Another factor which was observed, was the absence of any effect on the fundus particular): the macula, showing a lack of penetrance o1 the toxin into the intraocular fluid compartments. This could be due to its higher specific gravity as compared to the aqueous, which caused more of iris atrophy and keratitis to occur in the lower part. The third factor that was observed was the absence of progressive cataract and secondary glaucoma.
This case showed many features of similarity with the experimental lesions produced by bee strings in rabbits eyes as performed by Huwald. He had described persistent mydriasis unresponsive to miotics, iris depigmentation and sphincteric muscle atrophy. Keratitis and anterior capsular cataract were also described.
Unlike bee strings which are known to produce exudative iridocyclitis and hypopyon wasp stings produce a milder reaction in the eye. Landers has described an injury with a mud dauber wasp where mydriasis and temporary visual loss were attributed to a paralytic agent in the wasp venom. Corneal changes in the form of striate keratitis, ridges in the corneal epithelium recurrent corneal erosions and a bullous dystrophic condition have all been described as a result of bee and wasp
stings. Some times the sting may cause no reaction even if left indefinitely in the cornea.
The lenticular changes described are characteristically located in the anterior pole, are non-progressive and occur in the absence of a lenticular wound. All these features were seen in this case. The thinness of the capsule at the anterior pole could account for the location of the cataract, as its thinness makes it more susceptible to the effect of toxins.
| Summary|| |
A rare form of injury by the sting of a wasp is described. It presented certain characteristic features. The absence of any serious visual after effects is emphasised.
| References|| |
Rosenbrook, W.M. Jr. and R., 1964, Canad. J. Biochem. 42:1005.
Huwald, G., 1904, quoted by Young, C.A., 1931, Amer J. Ophthalmol. 14:208.
Nirankari, M.S. and Sangha, S.S., 1967, Orient. Arch. Ophthalmol. 5:125.
Landers, P.H. 1967, Amer J. Ophthalmol. 64:1168.
Purscher. A., 1949, quoted by Duke Elder, S., 1972. System of Ophtholmology, Vol. 14, part 2 p 1204 Henry Kimpton, London.
Kusano, 1914. quoted by Duke Elder, S.; 1972, System of Ophthalmology, Vol. 14, part 2, p 1204, Henry Kimpton, London.
Zahn, 1950, quoted by Duke Elder, S., 1972, System of Ophthalmology, Vol. 14. part 2. p 1204, Henry Kimpton, London.
Duke Elder, S, 1972, System of Ophthalmology Vol 14. Part 2, P. 1204, Henry Kimpton, London.
[Figure - 1]