The cause of ocular injuries from the reported cases in the literature was attributed to misidentification by the poorly sighted patients who were prescribed topical eye medications, patient carelessness who confuse the glue for over the counter eye drops, childhood curiosity resulting in accidental splashing of glue into the eyes while playing with the glue containers and deliberate forcible squirting of glue into eyes during assault
Fifty three cases of superglue injuries of the eyes have been published in the literature in the past thirty years. The most common clinical presentation was sticking of eyelids/eyelashes and inability to open the eye. The most common signs were tarsorrhaphy like appearance of the eyelids, conjunctival and corneal abrasion. The management included irrigation of the eye, trimming of eyelashes to remove the superglue attached to the lid margins and removal of the glue with forceps from the conjunctiva and cornea. The corneal abrasion was treated with topical antibiotics, mydriatics/cycloplegics and eye patching. In some cases conservative management was given i.e. antibiotic eye drops and allowing the glue to fall off by itself over a period of few days (). No serious ocular morbidity has been reported due to superglue injury. The age of patients varied from 3 months to 64 years and 25% of them were children.
Ocular findings and management of superglue ocular injuries reported in the literature.
The superglue tend will only bond the dry surfaces. When the glue drop or cream is instilled, the patient spontaneously blinks forcibly due to stinging or burning pain in the eye because of its chemical nature and the glue is forcibly pushed on to the lid margin and eye lashes. Since there is dry surface on the lid margins and eyelashes, the glue bonds these surfaces resulting in sticking of eyelashes or eyelid margins (ankyloblepheron) is very common in superglue injuries. The glue causes chemical conjunctivitis and keratitis when it comes in contact with conjunctiva or cornea.
There are two main principles in the management of ocular superglue injuries. (1) to reverse the chemically induced tarsorrhaphy so that detailed eye examination can be performed and visible superglue can be removed. (2) to identify the ocular damage by fluorescein staining and treat the ocular damage as per the standard protocols. Immediate irrigation of the eyes helps in removing some of the glue and reducing the rate of condensation of the glue, and severity of resulting tarsorrhaphy and ocular damage. The ankyloblepheron is treated by trimming of eyelashes and separation of lid margins without the need of any anaesthesia in adults; the same has to be done under general anaesthesia in children. In young children if the superglue ankyloblepheron is left untreated, there is a danger of development of amblyopia due to obstruction of visual axis by superglue.
The cyanoacrylate glue can be removed by using acetone
which is a solvent for the glue; but in the eye acetone may cause chemical injury to the conjunctiva and cornea. Removal of the glue on the lid margins can be tried by frequent cleaning with acetone swab. Rubbing of margerine
, high molecular weight oil, over the lid margins and eyelashes can be tried to remove the glue on the lid margins.
Superglues are cyanoacrylic derivatives. Those used domestically are lower alkyl derivatives than those designed for medical use and they have higher tissue toxicity
. The risk of ocular accidental application of superglues can be reduced by implementing changes in the package of their bottles which include childproof cap to prevent conventional opening of the bottle, distinctive shape of the bottles, different odour to alert the user, warning in bold print on the bottles, vertical ribs on the bottle
. Suggestions written on the bottle cover to keep them away from easy access to children and to keep them physically apart from bathroom cabinets and dressing table drawers will also lessen the risk of accentual instillation of superglue in the eyes.
Splashing of glue into the eyes was the mechanism of injury when the child (aged 1-10 years) was playing with glue
. There was inadvertent instillation of nail glue drops into 3 months old baby by mother mistaking as chloramphenicol eye drops, and a 3 years old child imitated her mother's action by putting eye drops in her own eye, but used nail adhesive instead
. Mandal et al
report 6 year old girl with accidental application of superglue to the left eye by her mother, inadvertently used as chloramphenicol eye ointment.
All the three cases in the present report are children and there was no serious ocular morbidity in any of them. The mechanism of injury in case 1 was the application of superglue by grand father of the child, mistaking it as antibiotic eye ointment (size and shape of the superglue tube looks similar to eye ointment tube). In case 2, the ocular injury was due to accidental splashing of glue while the child was playing with glue tube. In case 3, the injury was due to inadvertent squirting of glue into the eye when the baby pulled his mother's hand holding the superglue tube.
In conclusion, superglue injuries of the eye occur due to inadvertent application of glue because of mistaking nail glue drops for eye medication drops due to similar appearance of both bottles and because of mistaking glue tube as eye ointment tube due to similar appearance of both. Immediate medical aid will prevent ocular morbidity.