Fig. 8.2  Corneal abrasion from ocular exposure to detergents. Photo courtesy of the Krachmer JH, Palay DA. Cornea Atlas, 2nd edn, Mosby Elsevier, London, 2006.

no recent reports of serious eye injury with topical surfactant ­exposure, but animal studies show that high concentrations of certain detergents cause corneal scarring. There are recent reports of alkali liquid detergent packets causing moderate conjunctival and corneal injury in children without scarring. The surfactant in this product may have contributed to the injuries but the alkaline formulation (pH 9) probably exacerbated the toxicity. Benzalkonium chloride is a cationic surfactant that is commonly used as a preservative in eye drops. Several studies suggest that chronic use of eye drops containing this preservative may alter the tear filmepithelial interface on the ocular surface. Some pharmaceutical companies have recently brought to the market eye drops with alternative preservatives.

Although surfactants are not thought to penetrate through the cornea into the anterior chamber, there is considerable concern regarding the role of surfactants in the toxic anterior segment syndrome. Although this syndrome may have multiple etiologies, some cases have been tied to inadequate cleaning of intraocular instruments such as cannulas. It is suspected that residue from the detergents used to clean these instruments may not get fully rinsed off, making its way into the anterior chamber during subsequent cataract surgery and causing irreversible ­endothelial damage and corneal edema.

Recommendations

1. Detergent splashes into the eye are generally well tolerated and require brief rinsing with water. However, certain automatic dishwasher and laundry detergents are significantly alkaline and, in these cases, alkali burn protocols should be followed (see the section on alkalis).

2. If a surgery center suspects a series of cases of toxic anterior segment syndrome has occurred, efforts should be made to review the instrument cleaning protocol of the institution.

The use of disposable cannulas may reduce the likelihood of inadvertent inoculation of surfactant into the anterior chamber during intraocular surgery.

References and Further Reading

Baradaran-Dilmaghani R, Ergun E, Krepler K. Keratoconjunctivitis after exposure to party foam. Br J Ophthalmol 81(6): 515, 1997.

Cater KC, Harbell JW. Prediction of eye irritation potential of surfactant-based rinse off personal care formulations by the bovine corneal opacity and permeability (BCOP) assay. Cutan Ocul Toxicol 25(3): 217–233, 2006.

Debbasch C, Brignole F, Pisella PJ, et al. Quarternary ammoniums and other preservatives’ contribution in oxidative stress and apoptosis on Chang conjunctival cells. Invest Ophthalmol Vis Sci 42(3): 642–652, 2001.

De Saint Jean M, Brignole F, Bringuier AF, et al. Effects of benzalkonium chloride on growth and survival of Chang conjunctival cells. Invest Ophthalmol Vis Sci 40(3): 619–630, 1999.

Eleftheriadis H, Cheong M, Sandeman S, et al. Corneal toxicity ­secondary to inadvertent use of benzalkonium chloride preserved viscoelastic material in cataract surgery. Br J Ophthalmol 86(3): 299–305, 2002.

Fayers T, Munneke R, Strouthidis NG. Detergent capsules causing ocular injuries­ in children. J Pediatr Ophthalmol Strabismus 43(4): 250–251, 2006.

Gettings SD, Lordo RA, Feder PI, Hintze KL. A comparison of low ­volume, Draize and in vitro irritation test data. III. Surfactant-based ­formulations. Food Chem Toxicol 36(3): 209–231, 1998.

Jester JV, Maurer JK, Petroll WM, et al. Application of in vivo confocal microscopy to the understanding of surfactant-induced ocular irritation. Toxicol Pathol 24(4): 509–510, 1996.

Maudgal PC. Ocular burn caused by soft brown soap. Bull Soc Belge ­Ophthalmol 263:81–84, 1996.

Maurer JK, Parker RD. Light microscopic comparison of surfactant-induced eye irritation in rabbits and rats at three hours and recovery/day 35. Toxicol Pathol 24(4): 403–411, 1996.

Parikh C, Sippy BD, Martin DF, Edelhauser HF. Effects of enzymatic sterilization detergents on the corneal endothelium. Arch Ophthalmol 120(2): 165–172, 2002.

Class: Glues

Generic name: Cyanoacrylate adhesives.

Synonyms: Bucrilate, enbucrilate, mecrilate, ocrilate.

Proprietary names: Commonly known as ‘superglue’, available under many proprietary names.

Primary use

Household glue, artificial fingernail adhesive, surgical tissue ­adhesive (skin, cornea, mucous membrane).

Ocular side effects

Topical Ocular Exposure

Certain

1. Irritation

2. Eyelids – inadvertent adhesion of lid margins (Fig. 8.3) 3. Cornea – abrasion

4. Conjunctiva

a.Giant papillary conjunctivitis

b.Symblepharon and scarring

Probable

1. Lacrimal outflow system (as surgical plug) – dacryocystitis

2. Cornea (as surgical adhesive)

a.Infectious and inflammatory keratitis

b.Endothelial toxicity

3. Anterior chamber (as surgical adhesive)

a.Pupillary block

b.Irido-lenticular and irido-corneal adhesions

Glues Class: