Prognosis of Ocular Injury Caused by Wasp Sting: Case Reports

Hye-Jee Kim; Jae-Ho Shin; Sang Woong Moon

doi:10.3341/jkos.2016.57.12.1981

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Kim, Shin, and Moon: Prognosis of Ocular Injury Caused by Wasp Sting: Case Reports

Case Report

J Korean Ophthalmol Soc 2016;57(12):1981-1986.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1981

Prognosis of Ocular Injury Caused by Wasp Sting: Case Reports

Hye-Jee Kim, MD, Jae-Ho Shin, MD, PhD, Sang Woong Moon, MD, PhD

Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea

Address reprint requests to Sang Woong Moon, MD, PhD Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, #892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea Tel: 82-2-440-6162, Fax: 82-2-440-7756 E-mail: ophmoon@dreamwiz.com

Received 28 July 2016 Revised 23 September 2016 Accepted 16 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

In the present study, the prognosis of ocular injury caused by a wasp sting was evaluated in two cases: Case 1 was treated by anterior chamber irrigation and Case 2 was simultaneously treated by anterior chamber irrigation and vitrectomy.

Case summary

Both patients had unilateral damage and complained of severe eye pain and blurred vision. Severe corneal edema, conjunctival injection, marked anterior chamber inflammatory reaction and the wasp sting through the cornea at the anterior chamber were observed in both cases. In Case 1, anterior chamber irrigation was performed, however, corneal edema was not recovered. Six months after the wasp sting, phthisis was observed. In Case 2, anterior chamber irrigation and vitrectomy were simultaneously performed, corneal edema decreased and epithelial healing occurred. Four months after the wasp sting, the eyeball was stable, but there was no wave on the electroretinogram.

Conclusions

Unlike the ocular damage resulting from a bee sting, the ocular damage from a wasp sting causes severe toxic reactions and results in poor prognosis. Aggressive treatment including vitrectomy is necessary shortly after wasp sting injury to save both the vision and eyeball.

Keywords: Anterior chamber irrigation, Ocular wasp injury, Vitrectomy, Uveitis

References

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Figure 1.

Slit-lamp biomicroscopic photograph and vertical ultrasonography scan images of case 1. (A) Mucopurulent keratoconjunctivitis with chemosis and conjunctival injection was detected. (B) Severe anterior chamber reaction and a retained wasp stinger at the 6 o'clock position. (C) Ultrasonography scan image showed no significant abnormality. (D) Cornea edema and anterior chamber collapse with cataract was detected 1 month after injury.

Figure 2.

Slit-lamp biomicroscopic findings of case 2. (A, B) Initial presentation showed severe conjunctival chemosis, conjunctival injection, and total epithelial defect with severe corneal edema. Penentrating site of the wasp sting at 9 o'clock at the mid-periphery of the cornea (arrow). (C, D) Decreased corneal edema, corneal re-epithelization, and improvement of anterior chamber inflammation 1 month after initial visit.

Figure 3.

Vertical ultrasonography scan images of case 2. (A) Ultrasonography scan image showed choroidal edema at initial presentation. (B) Improved choroidal edema 1 month after injury.

Figure 4.

Examination from 4 months after injury in case 2. (A) The electroretinogram was normal on the right eye, but absent on the left eye. (B) Optical coherence tomography image from 4 months after injury demonstrating vitreous haze and atropic retina. Rt. = right; Lt. = left.

Table 1.

Systemic review of corneal Bee and Wasp sting

Species	Authors	Initial findings^*	1st visit	Initial VA	Surgical Treatment	Follow-up VA
Bee
	Chen et al⁷ (1986)	Hyphema	3 hr	–	Lentectomy	20/30
		Lens dislocation			Anterior vitrectomy
	Yildirim et al¹⁸ (1998)	Iris atropy	<1 hr	7/10	A/C irrigation	10/10
	Al-Towerki¹⁹ (2003)	Mild A/C reaction	3 days	2/200	None	20/60
	Teoh et al⁶ (2005)	Mild A/C reaction	12 hrs	Hand motion	Unsuccessful stinger remova	al Counting fingers
		RAPD (−)/RAPD (+)^†
	Razmjoo et al²⁰ (2011)	–	20 hrs	160/200	None	180/200
Wasp
	Kitagawa et al²¹ (1993)	Increased IOP	1 hr	Hand motion	None	Light perception
		Severe media opacity in A/C
	Lai et al¹⁰ (2011)	Severe media opacity in A/C	7 days	Light perception	None	Light perception
		RAPD(+)
	Kim et al¹¹ (2011)	Increased IOP	4 days	Hand motion	A/C irrigation	Phthisis
		Severe media opacity in A/C			AMT
	Nakatani et al¹⁷ (2013)	Severe media opacity in A/C	1 hr	Hand motion	A/C irrigation & vitrectomy	7/10
		Vitreous opacity

VA = visual acuity; hr(s) = hour(s); A/C = anterior chamber; RAPD = relative afferent pupillary defect; IOP = intraocular pressure; AMT = amniotic membrane tansplatation.

^* All cases include chemosis and corneal edema

^† After 1 week.

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