Dovepress Figure 2 A demonstration of our surgical procedure (A–D: four steps) in removing the deeply embedded stinger on the second day of follow-up. decreased gradually, and visual acuity improved to 180/200. However, slight subepithelial scarring remained around the area of the sting (Figure 1I). Discussion Here in this study we have described a patient with a deeply embedded bee stinger in the cornea. Our initial manage- ment included treatment with conventional drugs for eye injuries. However, complications (ie, stromal infiltration and edema) over the ensuing few days led us to choose a surgical approach to remove the stinger. In the literature, studies are controversial in respect of management strategies, depend- ing on the severity of ocular complications and the status of the stinger within the eye. Several studies recommend initial therapy with topical antibiotics and corticosteroids for the prevention of secondary infection and suppression of venom-induced inflammation.4,5,10 Analgetics and cyclople- gics were also reported to be beneficial in some instances.11 In a number of studies, the stinger was removed manually from the cornea in the first step by extracting its visible end from the cornea.2,11 However, external removal of the stinger can be difficult and is sometimes associated with the risk of leaving broken fragments within the cornea.4,9 Surgical removal of the retained bee stinger is still a matter of debate in the literature.4 Some authors suggest that surgical removal is not required in cases where the retained stinger is not associated with adverse ophthalmic complications.3,7,10 They postulate that once the venom from the bee stinger is neutralized, the stinger itself becomes completely inert and can remain within the cornea without causing further adverse reactions. In such studies, some cases were reported that the stinger remained within the cornea for many years asymptomatically. Gilboa et al7 addressed two patients with corneal bee sting in whom the stingers remained Clinical Ophthalmology 2011:5 Corneal bee sting protruding into the anterior chamber for 21 years and 28 years with no ocular manifestations. Additionally, Arcieri et al3 described a 12-year-old boy with a retained corneal stinger protruding into the anterior chamber. He was treated with topical antibiotic and corticosteroids for a period of 1 month, which resulted in marked resolution of the symptoms. The authors indicated that the retained stinger had not caused any ocular complication and was completely reabsorbed within 2 years of follow-up. Another similar treatment was used by Chuah et al10 in a case with a retained stinger fragment in the cornea with no adverse results. Aside from the aforementioned cases with conservative approaches, there are some instances in the literature in which retention of the stinger resulted in a severe corneal inflammation. Jain et al12 reported the case of a boy with a retained bee stinger that resulted in a state of kerato-uveitis. The stinger was removed surgically and symptoms improved. Moreover, Caça et al8 and Yildirim et al,9 in their studies, concisely addressed their surgical experience in removing deeply embedded stingers in patients who were complicated with corneal infiltration. Overall, it is generally accepted that immediate removal of the stinger is required in patients who are complicated with corneal infiltration and edema.12 In sum, leaving the stinger in place at initial stages depends on (1) severity of corneal reactions in the first hours (inflammation, infiltration, edema) and consequent visual outcome, (2) the distance of the stinger from the visual axis and consequent visual disturbances, (3) the ability of the physician to closely monitor over the ensuing weeks, and (4) most importantly, the depth of the protrusion and its external accessibility.7,10,12 Based on these factors, removal of the stinger at the slit lamp or in the operating room may be indicated and play a pivotal role in the management of corneal bee stings. In other words, stingers in the superfi- cial cornea can be readily accessed and removed at the slit lamp. However, deeply embedded stingers, especially those extending to the anterior chamber, need surgery. Herein, the methodology and the experience of the surgeon can determine the final outcome. In our case, the stinger was embedded into the cornea and could not be extracted externally. The patient was initially started with conventional treatment, including topical anti- biotics, corticosteroids, and cycloplegics. Notwithstanding, after 2 days of initial therapy, corneal infiltration and edema appeared. Subsequently, surgical removal of the stinger was planned. Unfortunately, there are few recommendations on the precise procedure of surgical removal of the stinger in the literature. As can be seen from Video 1, we made an submit your manuscript | www.dovepress.com Dovepress 1699