Endothelial dysfunction of the cornea after exposure to sprayed venom from hornets

Abstract

Purpose

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.

Observations

Case 1: 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. Case 2: 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/mm². 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/mm².

Conclusions and importance

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.

Keywords:

• Hymenoptera venom
• keratitis
• ocular injury
• corneal endothelium
• bullous keratopathy

Acknowledgements

None.

Authorship

All authors attest that they meet the current ICMJE criteria for Authorship.

Patient consent

Written informed consent was obtained from the patients prior to enrolment in this study and the preparation of the case reports. This study was conducted in accordance with the tenets of the Declaration of Helsinki. The authors contacted the Institutional Review Board of Miyata Eye Hospital, which confirmed that ethical approval was not required for these case reports in accordance with the ethical guidelines for medical and health research involving human subjects established by the Ministry of Education, Culture, Sports, Science and Technology; Ministry of Economy, Trade and Industry; and the Ministry of Health, Labour and Welfare.

Author contributions

Takashi Ono: Writing–Original draft preparation, Reviewing, and Editing; Data curation; and Investigation. Shigefumi Takahashi: Writing–Original draft preparation, Reviewing, and Editing. Takahiro Hisai: Writing–Reviewing and Editing; Data curation; and Investigation. Michiyo Kato: Reviewing and Editing; Data curation; and Investigation. Yosai Mori: Writing–Reviewing and Editing; Data curation; and Investigation. Ryohei Nejima: Writing–Original draft preparation, Reviewing, and Editing; Data curation; and Investigation. Takuya Iwasaki: Conceptualisation, Project administration, Supervision, Validation, Visualisation, Writing–review and Editing. Kazunori Miyata: Supervision, Validation, Visualisation, Writing–review and Editing.

Disclosure statement

The following authors have no financial disclosures: TO, ST, TH, MK, RN, YM, TI, and KM.

Data availability statement

The data generated during the current case series are available from the corresponding author on reasonable request.

Additional information

Funding

No funding or grant support.