Research

Bee Stinger: A Rare Intraocular Foreign Body

AAO Journal1d ago1 min read

A 23-year-old man presented with redness in the right eye for 2 days after a bee sting. On examination, his visual acuity was 20/20. Anterior segment examination showed conjunctival congestion with corneal stromal infiltrate at the limbus from 2 to 3 o'clock, with intact epithelium. Anterior chamber was deep, with partial heterochromia of iris nasally, pharmacologically dilated pupil, and clear lens (A). Intraocular pressure was 14 mmHg. Gonioscopy revealed a bee stinger in the nasal angle (B). Posterior segment examination was normal.

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AI Summary

Quick Take

A 23-year-old male presented with persistent ocular redness two days after a bee sting, maintaining 20/20 vision despite a corneal stromal infiltrate at the limbus. Gonioscopic examination revealed a rare intraocular foreign body—a bee stinger lodged in the nasal angle—demonstrating that stings can penetrate the globe even when initial symptoms appear localized.

Why It Matters

Ocular bee stings are often treated as superficial injuries, but this case highlights the risk of occult penetration into the anterior chamber. The presence of a stinger can trigger significant inflammation, iris heterochromia, and potential toxic reactions from venom components. It serves as a reminder that a high index of suspicion for intraocular foreign bodies is necessary in trauma cases, even when visual acuity is unaffected and the entry site seems minor.

Key Findings

Visual acuity remained 20/20 despite the presence of an intraocular foreign body in the anterior chamber.
Examination showed a corneal stromal infiltrate at the limbus (2 to 3 o'clock position) with an intact epithelium.
Gonioscopy was the definitive diagnostic tool, identifying the bee stinger lodged specifically in the nasal angle.
The patient exhibited partial heterochromia of the nasal iris, a notable clinical sign of the stinger's presence or venom interaction.
Intraocular pressure remained stable at 14 mmHg, and the posterior segment was unaffected.

Practice Implications

Clinicians should perform a thorough gonioscopic evaluation in any patient presenting with a history of ocular bee stings, even if the injury appears limited to the cornea. Monitoring for iris depigmentation or heterochromia is essential, as these signs may indicate the presence of a retained stinger or venom-induced tissue changes that require surgical intervention.

Who's Affected

OptometristsOphthalmologistsEmergency Department PhysiciansCornea Specialists

Evidence StrengthPreliminary

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