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

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

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

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?

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?

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 http://www.scottcamazine.com/photos/BeeSting/images/17beeStinging_jpg.jpg

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

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

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

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

Thank you! http://animalia-life.com/bee.html