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Bluebottle Envenomation–Induced Crystalline Keratopathy

Chui, Jeanie J PhD; Ooi, Kenneth G-J MSurg (Ophth); Reeves, Dianne FRCPA; Francis, Ian C FASOPRS, PhD

doi: 10.1097/ICO.0b013e318203cfdb
Case Report

Purpose: To report a patient who developed a crystalline keratopathy after bluebottle envenomation of the cornea.

Method: Case report with histopathological correlation and literature review.

Results: A 61-year-old man presented to the Ophthalmology clinic after he was stung in the left eye by a bluebottle while swimming in the sea. He complained of ocular and facial pain, facial swelling, and transient blurred vision. First aid by the beach included a hot shower and methoxyflurane for the pain. Crystalline deposits and pseudodendritiform epithelial defects were noted on slit-lamp examination. Topical chloramphenicol was prescribed, and 2 days after the injury, the cornea was debrided of persisting crystalline material. The cornea healed quickly after debridement with visual acuity improving from 6/9 to 6/6 in the affected eye. Microscopic examination demonstrated the corneal crystals to be irregularly shaped and nonrefractile with squared off edges. Raman spectroscopy partially identified the crystals as calcium based.

Conclusions: Although bluebottle stings of the cornea are infrequent, they may be challenging to manage. In addition to inactivation of the nematocysts and pain management, early debridement of the foreign matter may aid in the rapid resolution of the symptoms.

From the *Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, Australia; †Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia; and ‡Department of Anatomical Pathology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, Australia.

Received for publication July 2, 2010; revision received August 20, 2010; accepted October 20, 2010.

Financial Support: None.

Conflict of Interest: None to declare.

Reprints: Dr. Ian C. Francis, Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales 2031, Australia (e-mail:

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