What is the treatment for a jellyfish sting in the eye?

Treatment of Jellyfish Sting in the Eye

For a jellyfish sting to the eye, immediately irrigate copiously with seawater or saline, remove any visible tentacles without manual contact, and seek urgent ophthalmologic evaluation—this is an ophthalmic emergency requiring specialized care beyond standard first aid measures. 1

Immediate On-Scene Management

First Priority: Copious Irrigation

• Irrigate the affected eye immediately and copiously with seawater or saline to remove nematocysts and venom 1
• Seawater is preferred at the scene as it will not trigger additional nematocyst discharge, unlike fresh water which should be avoided 2, 1, 3
• Continue irrigation liberally to flush out as much venom and foreign material as possible 1

Tentacle Removal

• Remove any visible tentacles by lifting or pulling while avoiding direct manual contact 2
• If mechanical removal is not feasible, continue rinsing with seawater as an alternative 2
• Do NOT scrape tentacles, as this causes more hemolysis and venom release compared to gentle pulling 2

Critical Caveat: Vinegar Controversy

• While the 2015 American Heart Association guidelines recommended vinegar for jellyfish stings 2, the 2024 guidelines notably removed this recommendation 2
• Vinegar may cause massive nematocyst discharge in certain species (particularly Physalia) 4
• Given the sensitive nature of ocular tissue and species variability, avoid vinegar application to the eye 4, 5

Pain Management

Heat Therapy (Primary)

• After tentacle removal, apply hot water immersion/irrigation at 40°C (104°F) for pain relief 2
• This is the most effective first aid intervention for pain control based on human studies and systematic reviews 2
• Ensure water is nonscalding to avoid thermal injury to already compromised tissue 2

Topical Anesthetics (Alternative)

• Topical lidocaine cream or gel (4%-5% or 10%-15% formulations) may be reasonable if hot water is unavailable 2
• Lidocaine inhibits nematocyst discharge and decreases pain from multiple jellyfish species 2

Emergency Medical Care

When to Call Emergency Services

• Call emergency services immediately for: 2
  • Difficulty breathing
  • Signs of shock
  • Severe pain not controlled by first aid measures
  • Any systemic symptoms

Ophthalmologic Treatment

Once under medical care, ocular jellyfish stings require specialized treatment including: 1

• Topical cycloplegics for pain and to prevent synechiae formation
• Topical corticosteroids to reduce inflammation
• Topical antibiotics for infection prophylaxis
• Topical antihistamines for allergic component
• Careful removal of any remaining nematocysts under magnification

Expected Course and Complications

Typical Presentation

• Common symptoms include pain, conjunctival injection, corneal lesions, and photophobia 1
• Most patients recover without permanent sequelae 1
• However, symptoms may persist longer than 1 week in some cases 1

Potential Complications to Monitor

• Iritis 1
• Increased intraocular pressure 1
• Mydriasis and decreased accommodation 1
• Peripheral anterior synechiae 1

Critical Pitfalls to Avoid

Do NOT use: 2, 6, 4

• Fresh water (causes massive nematocyst discharge)
• Alcohol or methylated spirits (triggers nematocyst discharge)
• Pressure immobilization bandaging (stimulates additional venom discharge)
• Scraping motions to remove tentacles (increases hemolysis)

Key Clinical Point

While general jellyfish sting guidelines focus on pain relief and preventing further envenomation, ocular stings require urgent ophthalmologic evaluation regardless of initial symptom severity due to the risk of vision-threatening complications 1. The eye's delicate structures and potential for permanent damage elevate this beyond a simple first aid scenario, making prompt specialist assessment essential for optimal outcomes and quality of life preservation.