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| PHOTO ESSAY |
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| Year : 2022 | Volume
: 2
| Issue : 3 | Page : 794-795 |
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Wasp sting keratitis: A deceptive masquerader!
Aditya Ghorpade, Anitha Venugopal, Aditee Madkaikar
Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| Date of Submission | 21-Mar-2022 |
| Date of Acceptance | 14-Apr-2022 |
| Date of Web Publication | 16-Jul-2022 |
Correspondence Address:
Dr. Aditya Ghorpade
Department of Cornea and Refractive Surgery, Aravind Eye Hospital, S.N. High Road, Tirunelveli Junction, Tirunelveli - 627 001, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_737_22
Keywords: Bee sting keratitis, viral keratitis, wasp sting keratitis
How to cite this article:
Ghorpade A, Venugopal A, Madkaikar A. Wasp sting keratitis: A deceptive masquerader!. Indian J Ophthalmol Case Rep 2022;2:794-5 |
A 45-years-old male patient came to the hospital with complaints of pain and redness in the right eye since 1 day. He had a history of insect bite while driving a two-wheeler a day ago. Slit-lamp examination showed stromal edema mimicking viral keratitis; however, careful examination revealed a central small area of infiltration [Figure 1]a. Based on the characteristic clinical picture and absence of stinger in the affected cornea, we came to the diagnosis of wasp sting keratitis. Our patient was successfully treated with a tapering dosage of topical steroid dexamethasone 0.1%, showing complete resolution of stromal edema at the end of 2 weeks [Figure 1]b. | Figure 1: (a) Right eye on slit-lamp examination, showing stromal edema with a central small area of infiltration. (b) Complete resolution at the end of 2 weeks
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| Discussion | |  |
Isolated ocular insect sting injuries are a rare occurrence; however, they have grave consequences ranging from conjunctival chemosis, cataracts, and glaucoma to even optic atrophy and corneal decompensation leading to permanent ocular morbidity.[1],[2] Management can be difficult due to the non-identification of the exact insect culprit. Class Insecta of the phylum Arthropoda contains the superorder Hymenopterida, comprising wasps and bees.[3] Though the literature shows evidence of bee sting keratitis masquerading as viral keratitis,[2] it is rather difficult to come to the diagnosis in the absence of stinger, which is frequent in a case of wasp sting keratitis. Wasp venom contains non-enzymatic polypeptides such as melittin and mastoparan, which can cause a toxic reaction at the site of the sting in the form of corneal infiltrate. Amines such as histamine and tyramine can cause an inflammatory reaction in the form of stromal edema.[4] Though the surgical management in the form of anterior chamber irrigation is documented in the literature,[5] topical corticosteroids form the mainstay of the treatment as in our case. It is important to keep in mind the diagnosis of wasp sting keratitis in the absence of a stinger.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Gürlü V, Erda N. Corneal bee sting-induced endothelial changes. Cornea 2006;25:981-3.  |
| 2. | Jain V, Shome D, Natarajan S. Corneal bee sting misdiagnosed as viral keratitis. Cornea 2007;26:1277-8. |
| 3. | Klopfstein S, Vilhelmsen L, Heraty J, Sharkey M, Ronquist F. The hymenopteran tree of life: Evidence from protein-coding genes and objectively aligned ribosomal data. PLoS One 2013;8:e69344. |
| 4. | Nowroozzadeh M, Hamid A, Bolkheir A, Shirvani M, Maalhagh M. Corneal wasp sting: A case report and review of literature. J Curr Ophthalmol 2019;31:95-7. |
| 5. | Muto T, Machida S. Wasp sting of the cornea. Int Med Case Rep J 2018;11:283-6. |
[Figure 1]
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