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219 - Lésions oculaires par piqûre d'abeille, à propos d'un cas, et revue de la littérature

Bee eye stings are rarely described in the literature, and their management is controversial. The purpose is to describe ocular lesions after bee stings as well as their main complications and lastly analyse their still very controversial management. All of that was done thanks to a presentation of a case and an exhaustive review of ocular punctures by bee found in the literature

A 22-year-old beekeeper presented to our emergency department for a conjunctival bee sting. The eye had severe pain and conjunctival hyperaemia. The stinger was removed and topical antibiotic treatment with an anti-inflammatory agent was initiated, no complications were observed. We have established a summary table of all cases of ocular stings found in the literature via PubMed. We have described their main complications and treatment methods.

35 articles describing 56 cases of ocular punctures allowed us to evaluate the different clinical presentations, their possible complications and their management.

In the literature, the main complications are cataracts, anterior chamber inflammations, endotheliitis, optic neuropathies and intra-ocular pressure changes.

Out of the 56 cases of ocular stings 45 were men and 11 women.

After removal of the stinger and combined topical treatment with antibiotics and corticosteroids, no complications were detected in the case described. The usual management included the removal of the stinger and the introduction of a systematic topical treatment. Systemic treatment with corticosteroids to control complications can also be initiated.

The removal of the stinger is very controversial, analysis of the chart concerning the corneal stitches, most related lesions, showed that out of 51 cases, 43 benefited from the stinger withdrawal. Only 40% of withdrawal cases presented new complications. 

Among the cases of worsening after withdrawal were those who did not get any oral corticosteroid therapy (59%). 

Bee stings are responsible for complications, sometimes severe, by inoculation of toxins contained in the bee venom such as Melitin which is responsible of cataract, or Apamin responsible of optic neuropathy. The manipulation of the stinger retained in the cornea could favour a major inflammatory reaction by release of toxins, thereby causing new complications or preventing the complete healing of the lesions. Refrain from removing the stinger, accompanied by appropriate treatment leads some authors to leave the distal portion of the stinger in place. The treatment carried out mainly included: withdrawal of the stinger, topical treatment of steroidal anti-inflammatory drug coupled with antibiotics and this almost systematically. The introduction of a systemic treatment with corticosteroids is also widely recommended and would seem to prevent the appearance of complications or allow their resolution. In the literature we found the interest of using complementary examinations.

Removal of the stinger supplemented with minimal topical treatment with antibiotics and corticosteroids may be associated with systemic corticosteroid therapy, which most often helps to control the complications encountered. Regular initial follow-up with the use of complementary examinations allows optimal management.