Management of Corneal Bee Sting Injuries.

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.

Metastatic melanoma from unknown primary presenting as dorsal midbrain syndrome.

PURPOSE.: Dorsal midbrain syndrome, which is characterized by upgaze paralysis, light-near dissociated pupils, eyelid retraction, and convergence retraction nystagmus, can be caused by compression, ischemia, inflammation, or injury to the dorsal midbrain. Although brain metastases are common in certain cancers, including melanoma, only 3 to 5% occur in the brain stem. We present a case of metastatic melanoma from an unknown primary that initially presented as dorsal midbrain syndrome. CASE REPORT.: After a prodrome of intermittent nonspecific visual symptoms, a 60-year-old male veteran presented with bilateral upgaze paralysis and convergence retraction nystagmus. A single hemorrhagic lesion in the midbrain was causative. An inguinal mass with associated lymphadenopathy was subsequently discovered, and the biopsy from this site revealed malignant melanoma. A primary lesion was never found. The patient underwent surgical resection of the groin lesion and stereotactic radiosurgery for the midbrain metastasis but passed away 6 months after his initial presentation. CONCLUSIONS.: The presentation of bilateral vertical gaze paralysis, especially in the company of convergence retraction nystagmus, light-near dissociated pupils, or eyelid retraction, should raise concern for midbrain pathology. Although metastases to the midbrain are rare, they carry a grave prognosis, especially if melanoma is the primary malignancy, and most treatment options are considered palliative.

Pott's puffy tumour mimicking preseptal cellulitis.

Periorbital swelling can be secondary to local infections (for example, hordeolum) or reflective of an adjacent infection (for example, dental disease). Rarely, periorbital swelling can indicate underlying sinus disease; Pott's puffy tumour is a unique and serious form of this process. This paper presents an unusual way in which a smouldering sinusitis can erode through bone and result in orbital cellulitis or intracranial infection.

Automobile air bags: friend or foe? A case of air bag-associated ocular trauma and a related literature review.

BACKGROUND: Although air bags are placed in automobiles to act as safety devices, they have been shown to carry a risk of injury themselves. Ocular injury, in particular, can often be a direct consequence of air bag deployment. A case of ocular air bag injury is presented. A discussion and review of the current literature on this issue follows. CASE REPORT: A 63-year-old man was transferred to our clinic after sustaining injuries related to a motor vehicle accident, during which the automobile's air bag was deployed. Initial examination revealed many signs of blunt ocular trauma of the O.D., including iridodialysis, dislocated lens with traumatic cataract, and traumatic/inflammatory glaucoma. Initial B-scan showed an attached retina O.D. One month later, the patient underwent an attempted pars plana vitrectomy with lensectomy, iris repair, and insertion of an anterior chamber intraocular lens. Complications arose during the procedure, and a total retinal detachment developed. Resultant acuity is no light perception O.D. CONCLUSIONS: Although ocular morbidity can be a direct consequence of air bag deployment, most eye injuries are minimal, and seem to be outweighed by the benefits of air bags. Drivers, as well as passengers, can minimize associated injuries by adhering to specific safety guidelines. This, as well as continual modification and improvement in air bag design, will maximize the safety of air bags and decrease the incidence of vision-threatening ocular injury caused by air bag deployment.