A Report of Two Case of Ocular Toxicity Resulting from Direct or Indirect Bee Venom

Chan Ho Lee; Chang Hwan Lee; Moo Hwan Chang; Young Seung Seo

doi:10.3341/jkos.2019.60.4.399

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Lee, Lee, Chang, and Seo: A Report of Two Case of Ocular Toxicity Resulting from Direct or Indirect Bee Venom

Case Report

Journal of the Korean Ophthalmological Society 2019; 60(4): 399-405.

Published online: 17 April 2019

DOI: https://doi.org/10.3341/jkos.2019.60.4.399

A Report of Two Case of Ocular Toxicity Resulting from Direct or Indirect Bee Venom

Chan Ho Lee, MD, Chang Hwan Lee, MD, Moo Hwan Chang, MD, PhD, Young Seung Seo, MD

Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea.

Address reprint requests to Young seung Seo, MD. Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: 82-41-550-6479, Fax: 82-41-561-0137, mailcarr@naver.com

Received 2 August 2018 Revised 30 October 2018 Accepted 19 March 2019

The Korean Ophthalmological Society

(open-access):

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

To report a patient stung by a bee, who was diagnosed with sterile endopthalmitis and another patient diagnosed with optic neuritis, with decreasing visual acuity, after refined bee venom injection around the orbital tissue.

Case summary

A 82-year-old female visited our hospital for decreased visual acuity in the right eye and ocular pain due to a bee sting. The bee sting penetrated the sclera into the vitreous. In the anterior segment, severe cornea edema and anterior chamber cells were seen. Using ultrasonography, inflammation was seen around the intravitreal area. After 3 months, intravitreal inflammation regressed but the patient's visual acuity was light perception negative, and corneal opacity, neovascularization, and phthisis bulbi were detected. A 55-year-old male visited our hospital for ocular pain in the right eye and decreasing visual acuity after refined bee venom injection around the orbital tissue. The best-corrected visual acuity in the right eye was 15/100, there was moderate injection on the conjunctiva. A relative afferent pupillary defect, abnormal color vision test results, and a defect in the visual field test were observed. There was no pain during external ocular movement, and other general blood tests, and a brain MRI were normal. Based on these symptoms, methylprednisolone megatherapy was started for treatment of optic neuritis. After treatment, visual acuity of the right eye was 9/10 and all other clinical optic neuritis symptoms regressed.

Conclusions

Based on these two cases, ocular toxicity from bee venom could result from both direct and indirect courses. Treatment using refined bee venom might be harmful, and caution is recommended in its use.

Keywords: Bee venom, Inflammation, Optic neuritis

Figures and Tables

Figure 1

Slit-lamp biomicroscopic photograph and vertical ultrasonography scan images of case 1 in the right eye. (A) Severe mucopurulent keratoconjunctivitis with chemosis and bee's body was seen at the 9 o'clock position of the conjunctiva (black arrow) and the sting was penetrated into intraocular space. (B) Cornea edema with Descemet's membrane folds and large epi-defect was detected. (C) Ultrasonography B-scan image showed vitreous opacity which was considered as bee venom and inflammation and retina was flat. (D) Bee's sting length was calculated to be 4 mm and bee's body length was calculated to be 6 mm. (E) Ultrasonography B-scan image showed stationary vitreous opacity at 10 days after the bee sting injury. (F) Cornea edema, epi-defect, Descemet's membrane detachment (black arrow) and neovascularization on the cornea was detected at 1 month after the bee sting injury. (G) Phthisis bulbi was detected at 3 months after the bee sting injury.

Figure 2

Fundus photography and fluorescein angiography of case 2. (A, B) Fundus photograph showed no specific lesion including papilledema in both eyes. (C, D) Fluorescein angiography showed no specific lesion including leakage from optic disc in both eyes.

Figure 3

30-2 Humphrey visual field images of case 2. (A) In the right eye, inferior hemianopsia was seen. (B) In the right eye, there was no visual defect and improved mean deviation was seen on the second day from the start of steroid treatment.

Figure 4

Visual evoked potential images of case 2. (A) Decreased amplitude was seen at pattern visual evoked potential image in the right eye (black arrow). (B) Increased amplitude was seen at pattern visual evoked potential image at the end of the steroid treatment (black arrow).

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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