Insect sting of the lid; and a sequel.

AN anxious parent brought her 6-year-old son to me 2 or 3 years ago because he had been "stung on the eye by a bee". A cheerful and cooperative child showed me an irritable watery eye with some injection. It was quite definite that the insect had attacked the upper lid at about its mid point, for the site of puncture had been quite obvious at the time; no sign of this remained by the time the patient reached me 2 days later. There was no corneal stain, nor any sign of abnormality to be discovered on the upper tarsal conjunctiva-certainly no sting nor puncture hole. I was at a loss to explain the occurrence of injection and irritation from what I then thought to have been no more than a skin lesion; I prescribed some simple drops and asked that the patient should be brought back in 2 days' time. On his return the eye was as irritable as ever, and fluorescein staining and examination under the slit lamp revealed a multitude of the finest imaginable linear or slightly curved scratches. I had never seen such a delicate tracing. Eversion of the upper lid revealed, after close inspection, a slightly raised central area, a little redder than the rest of the conjunctiva; by manipulation of the lid after cocainization of the eye the business end of a sting was made to extrude itself; this was grasped with forceps and withdrawn. It is clear that the sting pierced the tarsal plate from the skin surface and intermittently protruded so as to touch the cornea-for this was non-staining at the time of the first visit, though the eye had obviously suffered recent irritation. The sting on examination proved to be indeed that of a honey bee; the characteristic barbs are unmistakable, and are shown here in surface and side view (Figs 1 and 2). These barbs retain the sting in position and