Miyata Eye Hospital, Miyazaki, Japan.
Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Cutan Ocul Toxicol. 2023 Dec;42(4):185-189. doi: 10.1080/15569527.2023.2227902. Epub 2023 Jun 30.
Ocular injuries due to Hymenoptera venom are uncommon and most injuries occur on the ocular surface. We reported two rare cases of corneal endothelial damage caused by hornet venom that was sprayed, not injected, through stinging in the eye.
: A 57-year-old male patient was injured when a hornet sprayed venom into his left eye. He was referred to our hospital because the edoema and epithelial erosion of the cornea persisted. The patient presented with bullous keratopathy, asymmetrical iris atrophy, irreversible mydriasis, and glaucoma. His cataract progressed, and his best-corrected visual acuity was 0.03. Cataract surgery was performed after anti-inflammatory treatment with steroids, and Descemet-stripping automated endothelial keratoplasty was performed 6 months later. The patient recovered well postoperatively: his best-corrected visual acuity improved to 1.0 and he continued his glaucoma treatment. A 75-year-old male patient had damage to his corneal epithelium, severe conjunctivitis, and conjunctival edoema when sprayed hornet venom entered his left eye. At initial presentation, the corneal endothelial cell density had decreased to 1042 cells/mm. The conjunctival sac was washed, and steroid and topical antibacterial instillations were administered. His best-corrected visual acuity improved from 0.07 at the initial visit to 0.5. However, the corneal opacification and glaucoma persisted, and 3 months later the corneal endothelial cell density decreased to 846 cells/mm.
Corneal injuries caused by sprayed hornet venom are rare; however, they can cause intense anterior chamber inflammation and severe, irreversible corneal endothelial damage. In such cases, prompt initial treatment, the administration of adequate anti-inflammatory medication, and careful evaluation of the corneal endothelium are required.
膜翅目毒液引起的眼部损伤并不常见，大多数损伤发生在眼表面。我们报告了两例罕见的因黄蜂毒液溅入眼内而引起的角膜内皮损伤的病例，这些损伤是通过蜇伤而不是注射引起的。
一名 57 岁男性患者左眼被黄蜂蜇伤，毒液溅入眼内。他因角膜水肿和上皮糜烂持续存在而被转至我院。患者表现为大泡性角膜病变、虹膜不对称性萎缩、瞳孔不可逆转扩大和青光眼。他的白内障进展，最佳矫正视力为 0.03。经类固醇抗炎治疗后行白内障手术，6 个月后行 Descemet 撕囊自动内皮角膜移植术。患者术后恢复良好：最佳矫正视力提高至 1.0，并继续接受青光眼治疗。另一名 75 岁男性患者左眼溅入黄蜂毒液后出现角膜上皮损伤、严重结膜炎和结膜水肿。初次就诊时，角膜内皮细胞密度已降至 1042 个细胞/mm。冲洗结膜囊，并给予皮质类固醇和局部抗菌滴眼剂。他的最佳矫正视力从初始就诊时的 0.07 提高到 0.5。然而，角膜混浊和青光眼持续存在，3 个月后角膜内皮细胞密度降至 846 个细胞/mm。
黄蜂毒液溅入引起的角膜损伤罕见，但可引起强烈的前房炎症和严重、不可逆的角膜内皮损伤。在这种情况下，需要及时进行初步治疗、给予足够的抗炎药物，并仔细评估角膜内皮。
