Corneal bee sting injuries with different presentations and outcomes - experience in a tertiary hospital in Malaysia. Corneal Bee Sting Injuries

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Jie Jie Lim
May May Choo, Prof
Yee Chian Liew, Dr
U-Teng Chan, Dr


Background: Bee sting ocular injuries are a relatively rare but significant source of ocular trauma. Bee sting ocular injuries can result from the bee stinger or its venom. The treatment depends on the mechanism and extent of the injuries.

Case Series: First patient had stinger removal almost immediately after the incident. However, his cornea eventually decompensated possibly due to venom toxicity. After cataract surgery and Descemet stripping endothelial keratoplasty, his visual acuity was 6/18.

Second patient was diagnosed with corneal perforation and toxic anterior segment syndrome in the left eye caused by bee stinger, which required tectonic penetrating keratoplasty. He later required cataract surgery which eventually resulted in secondary graft failure. 

Last patient had an intact embedded bee stinger paracentrally at 9 o’clock position in his right cornea. His lesion was initially treated as secondary bacterial corneal ulcer but his condition did not improve. After stinger removal and corneal suturing, he was treated with intensive topical antibiotics. His response to treatment and the periphery location of the lesion, led to good visual outcome. 

Conclusion: Corneal bee sting injuries can have different presentations and outcomes, whose management should be tailored individually in order to achieve good outcome. Proper protective eye wears should be advocated to motorcyclists to prevent such potential blinding condition.

Conflict of interest: The authors have no any conflict of interest.


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1. Gudiseva H, Uddaraju M, Pradhan S, Das M, Mascarenhas J, Srinivasan M, Prajna NV. Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes. Indian journal of ophthalmology. 2018 Feb;66(2):262.
2. Wright DN, Lockey RF. Local reactions to stinging insects (Hymenoptera). InAllergy and Asthma Proceedings 1990 Jan 1 (Vol. 11, No. 1, pp. 23-28). OceanSide Publications, Inc.
3. Siddharthan KS, Raghavan A, Revathi R. Clinical features and management of ocular lesions after stings by hymenopteran insects. Indian Journal of ophthalmology. 2014 Feb;62(2):248.
4. Gelincik A, İşsever H, Unal D, Işık E, Demirturk M, Gül H, İliaz R, Kara E, Ertek B, Özşeker F, Çolakoğlu B. The prevalence of Hymenoptera venom allergy in adults: the results of a very crowded city in Euroasia. Allergology international. 2015 Jan 1;64(1):35-40.
5. Chinwattanakul S, Prabhasawat P, Kongsap P. Corneal injury by bee sting with retained stinger. J Med Assoc Thai. 2006;89(10):1766-9.
6. Rai RR, Gonzalez-Gonzalez LA, Papakostas TD, Siracuse-Lee D, Dunphy R, Fanciullo L, Cakiner-Egilmez T, Daly MK. Management of Corneal Bee Sting Injuries. InSeminars in ophthalmology 2017 Mar 4 (Vol. 32, No. 2, pp. 177-181). Taylor & Francis.
7. Pal N, Azad RV, Sharma YR, Singh DV, Davda MD. Bee sting-induced ciliochoroidal detachment. Eye. 2005 Sep;19(9):1025
8. Kim JM, Kang SJ, Kim MK, Wee WR, Lee JH. Corneal wasp sting accompanied by optic neuropathy and retinopathy. Japanese journal of ophthalmology. 2011 Mar 1;55(2):165-7.

9. Isawumi MA, Hassan MB. Honeybee sting of the sclera: occular features, treatment, outcome and presumed pathogenesis. Pan African Medical Journal. 2014;17(1).
10. Höllhumer R, Carmichael TR. Bee sting of the cornea: A running case report. African Vision and Eye Health. 2015 Jul 17;74(1):3-pages.
11. Vélez M, Mannis MJ, Ortega JG, Tobón CA. Corneal hymenoptera stings: A new therapeutic approach. Vision Pan-America, The Pan-American Journal of Ophthalmology. 2012 Oct 22;11(4):117-20.
12. Vélez M, Salazar GI, Monsalve P. Bee sting of the cornea. Case report. Colombia Médica. 2010 Jun;41(2):176-8.
13. Gürlü VP, Erda N. Corneal bee sting-induced endothelial changes. Cornea. 2006 Sep 1;25(8):981-3.
14. Ang WJ, Kadir SZ, Fadzillah AJ, Zunaina E. A Case Series of Bee Sting Keratopathy With Different Outcomes in Malaysia. Cureus. 2017 Feb;9(2).