Introduction
Ocular injuries from bee stings are uncommon in urban populations, and appropriate therapy has yet to be determined. Bee stings to the eye can be excruciating and impair vision. Complications may include toxic keratopathy with severe, chronic corneal edema, keratouveitis, elevated intraocular pressure, cataract development, lens subluxation, hyphema, iris atrophy, optic neuritis, and toxic endophthalmitis, depending on the ocular location of the sting. Before medical presentation, the honeybee stinger is frequently removed from the stung site. However, the stinger is occasionally present at the initial inspection. Because of the risk of foreign body-induced inflammation, the stinger has traditionally been removed from the ocular tissue as soon as possible.
What Are the Symptoms of Bee Sting Ocular Injuries?
-
Sting injuries can harm several ocular structures. Patients often appear with an intensely painful, swollen eye; lids and adnexa are most commonly implicated.
-
These injuries are distinguished by redness, edema, and lacrimation. The region around the inoculation site may be indurated (stiff and nodular), and the retained stinger may be apparent.
-
Direct damage to the lid may result in tarsal penetration. Not only is a poisonous response conceivable in such instances, but the disembodied stinger may also cause ocular surface injury.
-
Direct stings to the ocular surface, such as the cornea or conjunctiva, are less common but considerably more dangerous.
-
Acute discomfort, hyperemia, and significant edema are common conjunctival signs, sometimes known as "watch glass chemosis."
-
Because venom from retained stingers can continue to diffuse into tissue long after the initial traumatic occurrence, they can be an additional source of irritation and injury.
-
When the cornea is directly affected, patients will have more discomfort and a localized inflammatory response at the inoculation site.
-
This may appear initially as localized, disciform edema, but tissue degeneration will ensue as the toxins affect the cellular structure.
-
White cell infiltration, as is an anterior chamber response, is prevalent within an hour of the damage.
-
A corneal sting injury may seem biomicroscopically similar to a foreign substance with infiltration or possibly infectious keratitis.
-
More profound ramifications can also be discerned. If the stinger enters the eye, it can cause a more severe and toxic uveitis.
-
Even more concerning, many reported cataract development due to wasp sting penetration into the anterior lens capsule. Cataracts can also form due to persistent, toxicity-induced inflammation.
-
Long-term alterations include bullous keratopathy, corneal neovascularization and opacification, chronic uveitis, iris atrophy, and secondary glaucoma.
-
In rare cases, the posterior section may also be involved. Several reports of sting-induced ocular neuritis, retinal injury, and ciliochoroidal separation have been reported.
What Are the First Aid of Bee Sting Ocular Injuries?
Though uncommon, bee stings can occur near or in the eye. A simple cold compress can cure a sting near the eye. However, you should visit an ophthalmologist if you are stung on the eyelid or cornea. Toxins in the bee stinger can induce irritation. Stingers are similarly sharp, having a saw-like shape that makes total removal difficult. The removal of bee or wasp stingers is debatable.
Around ninety percent of a bee's venom is delivered during the first 30 seconds of the sting, and removing a stinger after around a minute is unlikely to prevent additional venom injection into the eye. Most providers believe it should be removed if the stinger can be removed readily. However, physicians vary on when surgical removal is required. The treatment for bee and wasp stings differs depending on the location and severity of the injury. First aid may be sufficient for minor wounds.
-
The remaining stingers in the skin of the lids or adnexa should be gently removed, and the region should be cleaned with soap and water or Betadine (povidone-iodine, Alcon).
-
Cold compresses may assist in reducing the subsequent inflammatory reaction. Ice should be administered for no more than 20 minutes every hour (wrapped in a towel to avoid freezing the skin).
-
Oral antihistamines (for example, 10mg Loratadine) and anti-inflammatory medications (for example, 200mg to 400mg Ibuprofen.) may help manage related itching and discomfort. Sting injuries to the globe are more severe and require further treatment.
What Are the Treatments for Bee Sting Ocular Injuries?
-
Sting injuries to the globe are more severe and need further care. The stinger must be removed using the jeweler's forceps under biomicroscopy.
-
Medical therapy is confined to the eye surface if the inoculation site is the conjunctiva.
-
Topical antibiotics and corticosteroids, alone or in combination, are the most effective treatments for avoiding secondary bacterial infection and reducing accompanying inflammation.
-
Make careful to treat corneal injuries in the same way. Antibacterial medicines with a broad spectrum of action, such as Gentamicin or Fluoroquinolone, have been proposed.
-
Furthermore, stronger steroids (e.g., Prednisolone acetate 1 percent or Difluprednate 0.05 percent) should be used more often to treat concomitant uveitis. Cycloplegia with a powerful drug, such as Scopolamine or Atropine, is also advised. Treatment of uveitis immediately and proactively can help prevent long-term complications, including cataracts, iris atrophy, and glaucoma.
-
Early management with pulsed steroids may avoid irreversible vision loss in individuals with toxic optic neuritis caused by envenomation.
-
A three-day treatment of intravenous methylprednisone followed by a seven-day tapering dosage of oral Prednisone has been proven to assist individuals in restoring visual function after this damage.
-
Many individuals are left with a corneal scar, a cataract, glaucoma, or corneal edema after the inflammation has subsided. A corneal transplant and cataract surgery might be explored if a gas-permeable or scleral contact lens does not sufficiently restore eyesight from a corneal scar and the patient desires greater vision. Endothelial Keratoplasties (including Descemet's Stripping Endothelial Keratoplasties) and Penetrating Keratoplasty may treat corneal edema or restore eyesight from a central corneal scar.
-
A case of endophthalmitis caused by a bee sting (toxic versus secondary infection) necessitated a pars plana vitrectomy (PPV) with lensectomy. They claimed that after another penetrating keratoplasty, the patient's eyesight improved to 20/80.
-
As a result, a PPV may be a viable choice in some instances. An early anterior chamber washout has been reported to eliminate poisons from the anterior chamber after stings to the eye, particularly wasp stings.
Conclusion
Bee stings of the eye are uncommon, usually occurring at the cornea, and can result in sight-threatening consequences via various mechanisms. Toxins in the bee stinger cause a local inflammatory response. Furthermore, its pointed nature allows it to enter deeply, and its saw-like form and unique anatomic traits make total removal extremely difficult. Although ocular sting injuries are uncommon, primary eye care practitioners must be prepared for any eventuality. Early detection, thorough diagnosis, and rapid action can help avoid or reverse severe vision damage in many circumstances.
