1. Christine Martinez, MD COS 40th Annual Meeting August 19, 2016
A Buzzworthy Case
Christine Martinez, MD
COS 40th Annual Meeting
August 19, 2016

2. CC & HPI
10 yo M presents w/ pain and blurry vision in his R eye for 1 day
ROS (+) Redness, photophobia
No known PMH or POH
Presents to the Eye Clinic at Tenwek Hospital in Bomet, Kenya

3. Exam VA sc – 20/60 OD, 20/20 OS Pupils equal and reactive OU, no RAPD
No pressures obtained
On exam, his vision was down in the right eye, no APD, no pressures were obtained

4. Slit lamp exam
External – WNL OU
L&L – Mild lid edema OD
C&S – 4+ conjunctival injection w/ prominent limbal injection OD
K – Retained stinger superonasally with surrounding infiltrate and corneal edema OD
A/C – hypopyon, 4+ cell OD
Iris – round and reactive OU
Lens – clear OU
DFE – Normal
Any further questions? Differential Diagnosis?

6. Slit lamp exam
External – WNL OU
L&L – Mild lid edema OD
C&S – 4+ conjunctival injection w/ prominent limbal injection OD
K – Retained stinger superonasally with surrounding infiltrate and corneal edema OD
A/C – hypopyon, 4+ cell OD
Iris – round and reactive OU
Lens – clear OU
DFE – Normal
Any further questions? Differential Diagnosis?
If the stinger wasn’t immediately obvious, what else would you think about on a differential?

7. Corneal Bee Sting
Patient stung in the eye by a bee 1 day prior to presentation  retained stinger
Intense A/C reaction due to injected venom
Venom injected into the A/C  likely the cause of the intense A/C reaction

8. Management and Follow-Up
Attempted stinger removal w/ jeweler’s forceps  unsuccessful
Prescribed steroids, cipro, atropine
F/U 3 days later  never got the drops
Surprisingly, without treatment, eye much quieter
Returned to clinic 3 days later, likely unable to afford the drops

9. Stinger gone (no idea where or how
Stinger gone (no idea where or how!), hypopyon resolved, persistent corneal infiltrate

10. Here is a closer view. We again prescribed steroids and antibiotics, but the patient never followed-up again.

11. Buzzworthy
Approximately 40 cases of corneal bee sting reported in the literature
No previously described self-resolving cases
Unclear why stinger gone on follow-up
Hypopyon likely sterile and due to toxic/immunologic mechanism
Natural history of corneal bee sting?
We supposed that the stinger dislodged itself

12. Thank you!