Honeybee sting of the sclera: occular features, treatment, outcome and presumed pathogenesis.
Bottom Line: Medical treatment was instituted as soon as subject presented.The role of physical properties, immunological and genetics interplay and the presumed pathogenesis is further discussed.Health education on early presentation and avoidance of harmful traditional eye medications should be promoted among the farming populations in our communities, in order to prevent blinding complications.
Affiliation: Osun State University, PMB 4494 Osogbo, Nigeria.
Ocular bee sting injury has caused several reactions in the eye but has rarely been reported among local African farmers, and Nigerians in particular. This case seeks to report the first ocular and external eye reactions following a honey bee sting of the eye through the sclera, highlighting the treatment and outcome. Oral interview, clinical examination and external photographs were used to obtain and document findings. Medical treatment was instituted as soon as subject presented. There was complete inflammatory resolution within a week, normal vision and no evidence of stinger migration after four weeks of follow up. The wound site healed with ciliary staphyloma. The role of physical properties, immunological and genetics interplay and the presumed pathogenesis is further discussed. Health education on early presentation and avoidance of harmful traditional eye medications should be promoted among the farming populations in our communities, in order to prevent blinding complications.
Related in: MedlinePlus
Mentions: A 62 year old male farmer was attacked by a swarm of bees 2hours prior to presentation on account of severe pains. There were no previous trauma to the affected left eye or surgery, but had occasional itchy eyes. He is a known hypertensive with good control on medications, and not a known diabetic. He denied any history of harmful traditional eye medications(HTEM). Examination revealed tender swollen upper and lower lids, moderate to severe mechanical ptosis and purulent eye discharge (Figure 1). After eye toileting with normal saline, visual acuity, cornea, anterior chamber and pupillary reactions were normal but there was severe bulbar chemosis Figure 2. A swab of the discharge was sent for microscopy, culture and sensitivity (m/c/s). Treatment was thereafter instituted with Guttae Ciprofloxacin and Flurbiprofen, and oral Tramadol and NSAID. Eighteen hours after, all the symptoms had subsided. Further examination of the eye revealed a stab partial- thickness entry point of about 1 - 1.5mm in diameter in the sclera at 6 o’ clock position, 3.5 mm from the limbus and normal IOP. Dilated fundoscopy using binocular indirect ophthalmoscope, and slit lamp examination revealed normal posterior segment. There was complete resolution of the lid swelling, and chemosis within 72 hours apart from the conjunctival and episcleral hyperaemia. The purulent eye discharge stopped after 6 days and a tapered low dose oral Prednisolone was commenced. Four weeks follow up showed a self healing wound site in form of ciliary staphyloma and mild scleritis, with no evidence of erosion or irritation from a retained or migrated bee stinger (Figure 3). The result of the m/c/s showed growths of Staphylococcus aureus, and Staphyloccoccus epidermidis sensitive to ciprofloxacin, ceftazidine and erythromycin, which the topical antibiotics had taken care of.