ABSTRACT
PURPOSE: 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. CONCLUSION: 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.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Cornea/diagnostic imaging , Corneal Injuries/therapy , Eye Foreign Bodies/therapy , Glucocorticoids/administration & dosage , Insect Bites and Stings/therapy , Administration, Topical , Corneal Injuries/diagnosis , Corneal Pachymetry , Drug Therapy, Combination , Eye Foreign Bodies/diagnosis , Follow-Up Studies , Humans , Insect Bites and Stings/diagnosis , Male , Middle Aged , Tomography, Optical Coherence , Visual AcuityABSTRACT
Using the Optos Panoramic200 Scanning Laser Ophthalmoscope (Optos, Scotland, United Kingdom), clinically relevant findings anterior to the retinal surface, represented in digital ultra-wide field fundus images, were identified. Examples in this series demonstrate the potential for findings at the level of the crystalline lens and the full depth of the vitreous when imaging of the retina and choroid complex is undertaken. Clinicians interpreting these images should be aware of the potential contribution of information from anterior segment structures and the vitreous cavity. The information derived from anterior segment structures may enhance the diagnostic potential of the instrument.
Subject(s)
Aneurysm/diagnosis , Eye Diseases/diagnosis , Lasers , Ophthalmoscopy , Retinal Diseases/diagnosis , Adult , Aged , Aged, 80 and over , Female , Fundus Oculi , Humans , Male , Middle Aged , Retinal Vessels/pathology , Vitreous Body/pathologyABSTRACT
BACKGROUND: Glaucoma is typically an insidious-onset disease with serious visual consequences that has been positively linked to diabetes mellitus (DM) in several studies. We assessed the sensitivity and specificity of a diabetes teleretinal program to identify the glaucoma-suspicious optic disc. METHODS: Outpatients with DM (N = 1,644) presenting to Veterans Affairs ambulatory clinics participated in a nonmydriatic digital retinal imaging (NMDRI) program. Technicians transmitted digital retinal images electronically to readers for grading and eye care recommendations. Patients were referred for ophthalmic care based on the level of diabetic retinopathy and other ocular findings, including optic nerve changes suspicious for glaucoma. We retrospectively reviewed the electronic medical records of patients labeled as glaucoma suspects (N = 175) and compared them with those of patients from the same imaging pool who were not regarded as glaucoma suspects (N = 175). Ophthalmic data obtained from a comprehensive eye examination after digital retinal imaging was used to determine which patients met predefined criteria for the optic disc suggestive of glaucoma. RESULTS: Assessment of clinical data obtained after NMDRI found that 103 of 175 (59%) glaucoma suspects had glaucoma-suspicious optic discs. In the comparison group, only 7 of 175 (4%) had glaucoma-suspicious optic discs. CONCLUSIONS: Although specificity was high (96%), modifications in diabetes teleretinal imaging programs are needed to improve the sensitivity of detecting the optic disc that is suspicious for glaucoma.
