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Year : 2020  |  Volume : 68  |  Issue : 1  |  Page : 182

The “stung” cornea - Retained insect sting on the corneal endothelium

Department of Cornea and Anterior Segment, L V Prasad Eye Institute, Bhubaneswar, Odisha, India

Date of Submission03-May-2019
Date of Acceptance06-Aug-2019
Date of Web Publication19-Dec-2019

Correspondence Address:
Dr. Sujata Das
Department of Cornea and Anterior Segment, L V Prasad Eye Institute, MTC Campus, Patia, Bhubaneswar, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_840_19

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Keywords: Foreign body, insect, toxic keratitis

How to cite this article:
Das S, Sahoo S. The “stung” cornea - Retained insect sting on the corneal endothelium. Indian J Ophthalmol 2020;68:182

How to cite this URL:
Das S, Sahoo S. The “stung” cornea - Retained insect sting on the corneal endothelium. Indian J Ophthalmol [serial online] 2020 [cited 2020 Nov 28];68:182. Available from: https://www.ijo.in/text.asp?2020/68/1/182/273271

A 43-year-old male presented with the chief complaints of pain, redness, watering, and discharge in right eye (RE) following fall of an insect in the right eye 10 days back. Visual acuity in the RE was 20/25. On examination of RE, eyelids were edematous, conjunctival congestion was present, cornea had infiltrate 1*1.5 mm in size with surrounding stromal edema with a “V”-shaped foreign body on the endothelium [Figure 1]a, [Figure 1]b, [Figure 1]c. There was minimal anterior chamber reaction. Fundus of RE was within normal limits. On anterior segment OCT, two hyperreflective lesions were noted on the endothelium [Figure 1]d. A provisional diagnosis of retained insect sting resulting in toxic keratitis in the right eye was made. The patient was started on topical moxifloxacin hydrochloride 0.5% 2 hourly and topical prednisolone acetate 1% 4 times a day. After 1 week, patient was symptomatically better with decrease in congestion and size of infiltrate; but the sting persisted on the endothelium. The steroid was tapered weekly and 1 month after presentation, the area was scarred with no signs of inflammation but persisting sting on the endothelium. The patient is on regular follow up with no topical medication at present.
Figure 1: (a) Slit lamp photo of RE - diffuse illumination showing insect sting (yellow arrow) and stromal infiltrate (white arrow). (b) Slit lamp photo of RE - indirect illumination showing insect sting (yellow arrow) along with stromal infiltrate (white arrow). (c) Slit lamp photo of RE - optical section showing foreign body on the endothelium (white arrow). (d) AS-OCT image of RE showing two hyper reflective lesions on the endothelium (yellow arrows)

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  Discussion Top

Retained insect sting inside the eye is a relatively rare presentation. It may cause a number of ocular sequelae varying from corneal epithelial defect, corneal infiltrate to anterior uveitis, secondary glaucoma or rarely even posterior segment involvement leading to optic neuritis or optic atrophy.[1],[2] The effects may be due to the mechanical effect of the stinger or due to the venom of the insect inciting an inflammatory response.[3] Prognosis will depend on time of presentation and severity of presentation. The sting, if superficial, should be removed but if it is embedded deeply and is not causing inflammation, it may be left as such.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Song HS, Wray SH. Bee sting optic neuritis: A case report with visual evoked potentials. J Clin Neuroophthalmol 1991;11:45-9.  Back to cited text no. 1
Arcieri ES, França ET, De Oliveria HB, Ferreira L, Gerreira MA, Rocha FJ. Ocular lesions arising after stings by hymenopteran insects. Cornea 2002;21:328-30.  Back to cited text no. 2
Razmjoo H, Abtahi MA, Roomizadeh P, Mohammadi Z, Abtahi SH. Management of corneal bee sting. Clin Ophthalmol (Auckland, NZ) 2011;5:1697-700.  Back to cited text no. 3
Höllhumer R, Carmichael TR. Bee sting of the cornea: A running case report. Afr Vis Eye Heal 2015;74:3-5.  Back to cited text no. 4


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