Sympathetic Ophthalmia after Ocular Wasp Sting

Dear Editor, Although wasp stings are common environmental injuries , those regarding the eye are rare. Symptoms vary from mild hyperemia to sight-threatening complications [1-4]. Wasp stings to the eye lead to a mechanical insult caused by stinger penetration, resultant toxicity, and an immune response [1]. A few reports have documented ocular inflammation induced by the venom or a retained stinger. In most cases, intraocular inflammation is treated with ste-roids or by removal of the stinger [2,3]. However, we encountered a case of severe panuveitis after an ocular wasp sting which could not be controlled by conventional therapy , resulting in sympathetic ophthalmia (SO) of the fellow eye. To our knowledge, this is the first report of SO induced by wasp venom. A 53-year-old man was stung in his right eye, and one day later, arrived at Kyungpook National University Hospital with complaints of visual disturbance. The best-corrected visual acuity (BCVA) was hand motion and intraocu-lar pressure (IOP) was 34 mmHg. We observed conjunctival injection, marked corneal edema with folds in Descemet's membrane, epithelial defects, stromal opacity, and severe anterior chamber reaction. Corneal and perilimbal infiltration was noted between 8 and 10 o'clock (Fig. 1A). The wasp stinger could not be identified during slit-lamp examination. The lens and fundus were obscured by corneal edema and anterior chamber reaction. B-scan ultrasonog-raphy showed hyperechoic signals in the vitreous. The patient was diagnosed with panuveitis, keratitis, and secondary glaucoma, and conservative treatment was initiated with moxifloxacin ophthalmic solution 0.5%, prednisolone acetate 1%, atropine sulfate 1%, fixed-combination dorzol-amide/timolol, sodium hyaluronate 0.1% eye drops, oral prednisolone, and an antihistamine. The following day, the corneal edema had reduced, but keratic precipitates were observed (Fig. 1B). After one week, BCVA deteriorated to no light perception. Two months later, BCVA and IOP of the affected eye were not changed, but corneal stromal infiltration had remarkably worsened (Fig. 1C), and the patient complained of visual disturbance with conjunctival injection in the fellow eye, despite a visual acuity of the fellow eye was 20 / 20. However, IOP was 32 mmHg, and slit-lamp examination revealed keratic precipitates, with mild inflammatory reactions in the anterior chamber and vitreous (Fig. 1D). Fundus examination showed multiple small whitish-yellow infiltrations at the posterior pole and Fig. 1. Changes of the injured and fellow eyes after wasp sting. (A) Slit-lamp examination of the right eye shows infiltration of the corneal and perilimbal sclera (black arrow). …