Paediatric ocular super glue injuries: assessment of two cases

Abstract

In this report, we elaborate the clinical findings and the optimal management of two cases with ocular glue injuries in two paediatric patients. Both the patients were presented to the ocular emergency with completely closed eyelid and periocular erythema. The eyelids were completely closed due to matting of the eyelashes with glue retention up to lash roots. Thus, in both cases, after the application of local anaesthetic agent, immediate lash trimming was performed along with the removal of crystallised glue particles. However, the ocular surface showed only congestion in absence of any added corneal complications. Patients were followed up with standard treatment protocol as per chemical injuries. Until the end of 5 months, the clinical course was uneventful.

Background

Paediatric ocular injuries due to various causes like trauma,¹ and firecrackers,^{2 3} are of great concern as far the paediatric ocular health is concerned. In the same manner, ocular complications due to commercially available super glue in various forms have been noted in few occasions in literature.^4–8 The glue is not immediately harmful to the ocular surface.^{8 9} Here, in this report, we elaborate two paediatric cases with ocular injury due to super glue. The evaluation, preferred mode of management and long-term outcomes have been highlighted here.

Case presentation

Case 1: a 10-year-old boy was brought to the ocular emergencies with the history of glue injury to the right eye. The duration of injury was 2 hours. Clinical examination revealed redness and excoriation along the right upper and lower eyelids. There was matting of the eyelashes; the crystallised glue was found within the matted eyelashes (figure 1A). The eyelid margins were completely adhered. After cleaning the periocular area, topically proparacrine anaesthetic eye drops were installed. The eyelid separation was difficult as the lashes were completely stuck. Thus, eyelashes were trimmed, and the ocular surface was examined (figure 1B). The palpebral surface of the eyelids and fornices were free from the glue residuals. Cornea was clear without any epithelial staining; however, the conjunctiva showed mild diffuse chemosis. Thorough ocular surface irrigation was performed with normal saline, and the patient was prescribed topical moxifloxacin hydrochloride eye drops 0.5% three times a day, topical cyclopegia (homatropine 2%) four times a day, topical prednisone acetate six times a day, sodium citrate and sodium ascorbate 10% 2 hourly for 1 week then tapered over 4–6 weeks. At the end of 2 weeks, the periocular oedema was completely resolved in absence of any additional complications, and the visual acuity at the end of 2 weeks was 20/20.

Figure 1.

(A) In case 1, the eyelids completely adhered with periocular redness, swelling and erythema. (B) After complete trimming, the eyelashes of both the eyelids the ocular surface was clear without any added complications.

Case 2: similarly, in the second case, an 8-year-old girl was brought with the history of glue injury of 4 hours’ duration. As mentioned in the previous case, a similar treatment protocol was followed to achieve a symptom-free ocular surface with normal visual acuity at the end of 2 weeks (figure 2A,B).

Figure 2.

(A) In the second case after trimming the eyelids, the residual glue particles can be seen along the lash margins. (B) At the end of 2 weeks, the clinical course was uneventful with a normal recovery of visual acuity.

Outcome and follow-up

In both cases at the end of 5 months, the clinical course was uneventful.

Discussion

It is important to note that the ophthalmologist working in ocular emergencies may encounter cases with such difficult clinical scenarios. Under such circumstances, a detailed history should be elicited from the caretakers or the accompanying relatives regarding the nature of chemical that accidentally entered the eye, duration and earlier manipulation/treatment if at all received already. The usual clinical features include periocular redness, excoriation, watering and completely adhered eyelids due to matting of the eyelashes secondary to the adhesive property of the glue.

These injuries are usually incurred by the verbal and preverbal school children following accidental handling or unexpected exposure from the bystanders. It is the parents and caretakers who should make sure regarding the reach to such hazardous material by their children. Similarly, while handling these materials, self-protective measures need to be taken with active avoidance of another unprotected individual besides them. While opening the tubes/containers, it should be performed gently, and the forces used should be less and directed away from once body/face.

In our cases, the crystallised glue covered the eyelashes evenly and densely from the tip of eyelashes to their roots and surrounding skin. Thus, just by separation of the eyelashes by force or other manoeuvres may not completely cure of residual glue matter.^7–9 At the same time in both cases, the crystallised glue particles were limited to the lid, lash and the skin, which may be because of the reflex spasm of the orbicularis muscle to the foreign material during the incident, thus limiting the entry of the glue into the eye.

The treatment involves a careful separation of the eyelid margins. Cooperative children of more than 8–10 years are likely to comply for the eyelid separation with minimally painful manipulation. However, using a muscle hook by inserting it from the medial canthal region and application of sufficient force to separate the lid margins has been noted.⁹ However, this may not be fruitful in all cases, because as we have already mentioned in this article that the crystallised glue particles were densely adherent to the eyelashes in their entirety from tip to the roots and which will not be cleared just separation of the eyelids. Second, forceful separation of the eyelids may pluck the eyelashes from their roots leading to permanent loss of the lashes. Thus, eyelash trimming seems to be an appropriate option in terms of lesser manipulation, lesser pain and complete removal of the glue from eyelid surface.

Learning points.

• Ocular injuries due to glue are not routinely encountered in clinical practice, and fortunately, these chemicals are not that harmful to the ocular surface.

• Under these circumstances, careful ocular evaluation followed by appropriate management options should be undertaken to remove the harmful chemical substance from eyelid and ocular surface.

• From these observations, we prefer trimming of the eyelashes for complete removal of the glue particles from the skin and ocular surface and also to minimise further ocular surface damage with forceful techniques.