Long-Term Monitoring of an Intracorneal Bee Stinger Using Anterior Segment Optical Coherence Tomography and In Vivo Confocal Microscopy

Abstract: – A 19-year-old male patient presented to our clinic with complaints of foreign-body sensation, pain, redness, tearing, and decreased vision in the right eye. One day prior, a bee struck his eye while he was riding a motorcycle. Biomicroscopic examination of the right eye showed periorbital edema, chemosis, ciliary injection, corneal edema with radiating Descemet folds, paracentral corneal infiltrate, and a brown needle-like foreign body resembling a bee stinger. Anterior segment optical coherence tomography (AS-OCT) confirmed corneal edema with Descemet folds, whereas in vivo confocal microscopy (IVCM) revealed multiple hyporeflective, round cyst-like structures within the superficial corneal epithelium, hyperreflective, round inflammatory cells around the subbasal nerves, a honeycomb pattern, and a hyperreflective, needle-like linear opacity in the stroma. The patient was treated with topical moxifloxacin 0.5%, dexamethasone 0.1%, and fluconazole 0.2% eye drops and oral moxifloxacin (400 mg) and cetirizine (10 mg) tablets. The patient's signs and symptoms improved significantly within 1 week. At the 18-month examination, the patient's vision was 20/20, with only a faint stromal opacity remaining. No stinger fragments were detected on biomicroscopic examination, AS-OCT, or IVCM examination. Anterior segment optical coherence tomography and IVCM are highly valuable for monitoring corneal edema, inflammation, cellular changes, and the embedded stinger within the cornea throughout the follow-up period.