Abstract
BackgroundTo report a rare case of bee sting presumed endophthalmitis that resulted in a devastating ocular outcome.Case presentationA 43-year-old patient presented 24 h after bee sting ocular injury in his left eye. He had a mild inflammatory sign at presentation, and he underwent surgical exploration to rule out a scleral defect, which revealed a sealed defect. During his hospital course, he developed signs of endophthalmitis 48 h following trauma for which he received vitreous tap and intravitreal antibiotic. Microbial culture revealed gram-negative rods, Pseudomonas aeruginosa, and Aeromonas veronii. Condition escalated to reach the panophthalmitis stage and cellulitis like picture with visual acuity of no light perception. Visual evoked response (VER) demonstrated a flat response. Infection was controlled by evisceration of the globe at the end as salvage therapy against the spreading of infectionConclusionsBee sting ocular injury is an exceedingly rare type of ocular trauma. Concomitant infection can happen, and severity depends on the pathogen involved. It is crucial to have insight and start appropriate treatment based on to the patient presentation.
Highlights
Bee bites can cause ocular injuries [1,2,3,4]
Concomitant infection can happen, and severity depends on the pathogen involved
Ciliochoroidal detachment and endophthalmitis have been reported in very few reports [6,7,8]
Summary
Bee bites can cause ocular injuries [1,2,3,4]. Local and systemic effects that can happen is related to toxins released from venom contained in the sting, the eye-related injuries reported are conjunctivitis, corneal infiltrates, cataract formation, iritis, hyphema, lens subluxation, and optic nerve damage secondary to glaucoma [5]. Patient developed significant corneal edema with high intraocular pressure (40 mm HG), that was managed by oral acetazolamide 250 mg four times daily, timolol maleate (timabak 0.50%) drop twice daily, latanoprost (xalatan) 0.005% once daily and brimonidine tartrate (alphagan-p-0.15%) twice daily His course after surgery was deteriorating with poor vision (light perception), more pain, corneal edema, and development of hypopyon over 24 h period. Thirty-six hours post operatively his vision in the left eye drop to no light perception, another B-scan Ultrasonography examination (Fig. 1B) showed more vitreous opacities and retina and choroid (RC) layer thickening suggesting endophthalmitis, patient received intravitreal antibiotic of vancomycin 1 mg/0.1 ml and ceftazidime 2.25/0.1 ml and dexamethasone 0.4 mg/0.1 ml. Evisceration done and patient continued his course of intravenous antibiotics without systemic spread of infection, and he was discharge in stable condition
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