The incidence of bee stings (including multiple bee stings) is increasing globally, putting more and more patients at risk, especially those allergic to bee venom. This article presents a case of a bee sting in the eyeball of a patient.

When stung, susceptible patients can experience anaphylactic shock, rhabdomyolysis, or renal failure. But what happens when a patient is stung in the eyeball? One unfortunate 55-year-old man found out, according to a June 2024 case report published in the New England Journal of Medicine (NEJM).[1] 

The patient was stung by a bee in his right eye, leading him to seek care at his local emergency room. There, physicians thought they had removed the entirety of the stinger the bee left behind.[2] 

Two days later, however, the patient’s vision had worsened dramatically, leaving him barely able to see. According to the NEJM report, “vision in the right eye was limited to counting fingers.”[1] His pain had also increased, and he began bleeding from the vessels in his iris—known as a hyphema.[2] 

The patient sought medical attention at Wills Eye Hospital in Philadelphia, PA. To determine the location of the stinger, physicians performed a slit lamp examination with fluorescein dye, which, as the NEJM article states, “stains epithelial defects yellow-green.” 

Under the slit lamp, physicians found remnants of the tiny stinger still embedded in the eye. “It showed conjunctival injection, inferior corneal oedema, and an infiltrate at the nasal limbus with a piece of retained stinger,” the report states. The limbus is the space between the cornea and the sclera.[3] Additionally, the patient’s intraocular pressure was 16 mm Hg, which is near the upper end of the reference range (12 to 21 mm Hg). Jeweler’s forceps were used to remove the stinger remnant, and prednisolone eye drops and topical antibacterial medication were prescribed. Five months later, the patient’s case improved, with visual acuity at 20/25—just under the normal range.[4] 

Benjamin Bert, MD, a board-certified ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, says patients shouldn’t worry about suffering the same fate, as stings directly to the eyeball are uncommon. 

"While both the bee’s venom and the sting itself can cause a reaction. In this case, it was the stinger itself that acted as a biological foreign object causing further reaction. The stinger acts like a splinter.” 

-Dr Bert

He also says where a person is stung matters: “It makes a significant difference depending on which part is being affected. Certain parts have an immune-mediated response, while other parts do not have a rapid innate response…and can take longer [to show symptoms].” Dr Bert adds that, in this case, the stinger was off to the side of the cornea; if it were in the centre, it may have caused permanent damage.

He also notes that patients should be taught that rubbing or pressing the eye should be avoided for any kind of eye injury. “Flush the eye with a sterile solution or with any available water,” he says. “And if the sensation doesn’t go away in minutes or there is a concern that a foreign body is in the eye, get evaluated sooner [rather] than later.” He adds that the problem will only worsen, and take longer to treat and improve if a patient doesn’t take immediate action. Ultimately, seeing an optometrist is key—and not only because they have slit lamps, he notes.

Dr. Bert says that patients have also been stung around the eye, which is a slightly different issue. In this case, patients could expect “the soft tissue and superficial parts of the eye to expand, even to the point where the eye is closed. The concern would be bacteria getting into the skin as well,” he says. If your patient experiences fevers, chills, preseptal cellulitis, or an infection, they may need oral antibiotics.

Disclaimer: This story is contributed by Lisa Marie Basile and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.