title: Management of Corneal Bee Sting Injuries.
abstract: OBJECTIVE
  To review the management of keratitis after corneal bee stings and to report a case of deep stromal corneal infiltrate secondary to a retained bee stinger managed conservatively in a patient who presented three days after unsanitary manipulation of the stinger apparatus.
  
  
  METHODS
  Case report and review of literature.
  
  
  RESULTS
  A 57-year-old male beekeeper was evaluated for pain, blurry vision, and photosensitivity after a corneal bee sting. Of note, the venom sac had been removed with dirty tweezers three days prior to his visit. On exam, a focal infiltrate with diffuse edema was seen surrounding a retained bee stinger in the peripheral cornea. Trace cells in the anterior chamber were also noted. Based on a high suspicion for infectious keratitis, a conservative treatment strategy was elected. Administration of broad-spectrum topical antibiotics with concomitant abstention of corticosteroids led to rapid resolution of the symptoms. Over 16 months of follow-up, the stinger has remained in situ without migration and the patient has maintained 20/20 visual acuity without complications. There is debate on the preferred method for the management of corneal injury secondary to bee stings, especially when it is associated with a retained stinger. We herein present our findings in our appraisal of reported cases.
  
  
  CONCLUSIONS
  In the aftermath of an ocular bee sting, close surveillance for inflammation and infection is essential. Individual manifestations of these injuries vary in timing, type, and severity; therefore, the accessibility of the stinger and the evolving clinical picture should guide therapeutic decisions.
authors.affiliation: a Veterans Affairs Boston Healthcare System , Boston , MA , USA.|b Department of Ophthalmology , Boston University School of Medicine , Boston , MA , USA.|c Department of Ophthalmology , Harvard Medical School , Boston , MA , USA , and.|d Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , MA , USA.
authors.forename: Ruju R
authors.initials: RR
authors.lastname: Rai
authors.affiliation: a Veterans Affairs Boston Healthcare System , Boston , MA , USA.|c Department of Ophthalmology , Harvard Medical School , Boston , MA , USA , and.|d Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , MA , USA.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Gonzalez-Gonzalez
authors.affiliation: a Veterans Affairs Boston Healthcare System , Boston , MA , USA.|c Department of Ophthalmology , Harvard Medical School , Boston , MA , USA , and.|d Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , MA , USA.
authors.forename: Thanos D
authors.initials: TD
authors.lastname: Papakostas
authors.affiliation: a Veterans Affairs Boston Healthcare System , Boston , MA , USA.|b Department of Ophthalmology , Boston University School of Medicine , Boston , MA , USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Siracuse-Lee
authors.affiliation: a Veterans Affairs Boston Healthcare System , Boston , MA , USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Dunphy
authors.affiliation: a Veterans Affairs Boston Healthcare System , Boston , MA , USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Fanciullo
authors.affiliation: a Veterans Affairs Boston Healthcare System , Boston , MA , USA.
authors.forename: Tulay
authors.initials: T
authors.lastname: Cakiner-Egilmez
authors.affiliation: a Veterans Affairs Boston Healthcare System , Boston , MA , USA.|b Department of Ophthalmology , Boston University School of Medicine , Boston , MA , USA.|c Department of Ophthalmology , Harvard Medical School , Boston , MA , USA , and.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Daly
mesh_terms: D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003315:Cornea / Q000000981:diagnostic imaging*; D065306:Corneal Injuries / Q000175:diagnosis / Q000628:therapy*; D063171:Corneal Pachymetry; D004359:Drug Therapy, Combination; D005129:Eye Foreign Bodies / Q000175:diagnosis / Q000628:therapy*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007299:Insect Bites and Stings / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids
keywords: Bee sting; cornea; endothelial cell; hymenoptera; keratitis; specular microscopy; stinger removal; trauma; venom