Ocular Bee Sting Injury a Rare Cause of Endophthalmitis

Ophthalmologists in Saudi Arabia have reported a rare case of bee sting-related endophthalmitis that resulted in loss of vision and required evisceration of the globe to control the infection. The report was presented at the American Society of Retina Specialists 40th Annual Meeting, held in New York, New York, July 13-16, 2022.

Algethami Ahmed Radi , MD, of King Abdullah Medical City, Makkah, Saudi Arabia, and colleagues shared the retrospective case presentation of a 43-year-old patient who presented at the Emergency Room of King Khaled Eye Specialist Hospital with ocular pain and redness and mild inflammation with loss of vision in his left eye following trauma by a bee sting that occurred 24 hours prior to presentation. 

He underwent ophthalmic examination, which indicated a best corrected visual acuity (BCVA) of poor light perception in the right eye and 20/200 in the left. The left eye had previously been documented to have a BCVA of 20/20. 

The ophthalmology team conducted slit lamp examination of the left eye, which indicated moderate conjunctiva injection and a 1 mm×1 mm conjunctival defect with inferior temporal subconjunctival hemorrhage, a clear cornea, and no leak. They observed a fibrinous reaction in the anterior chamber, early cataract changes, vitreous hemorrhage, and hazy view to the fundus. They also found thickening of the sclera at wound site with B-scan ultrasonography.

During his hospital stay, the patient developed signs of endophthalmitis 48 hours following trauma. He was administered vitreous tap and intravitreal antibiotic. With microbial culture, the team discovered gram-negative rods of Pseudomonas aeruginosa and Aeromonas veronii. 

The patient’s ocular condition worsened to panophthalmitis with orbital cellulitis and visual acuity of no light perception. In a visual evoked response test, there was a flat response. To prevent spread of the infection, the patient’s care team eviscerated the globe as salvage therapy.

“Bee sting ocular injury is an exceedingly rare type of ocular trauma,” according to the presenters. “Concomitant infection can happen, and severity depends on the pathogen involved. It is crucial to have insight and start appropriate treatment based on the patient’s presentation.”

Reference

Radi AA, Mohammed A, Huda A. Bee sting presumed endophthalmitis-a devastating ocular outcome. Poster presented at: The 40th annual meeting of the American Society of Retina Specialists; June 13-16, 2022; New York. Poster 234.