J Korean Ophthalmol Soc.  2012 Jul;53(7):1030-1034. 10.3341/jkos.2012.53.7.1030.

A Case of Keratoconjunctival Chemical Injury from a Topical Anesthetic Ointment

• Shin JH
• Chung JK

• KMID: 2215865
• DOI: http://doi.org/10.3341/jkos.2012.53.7.1030

Abstract

PURPOSE
To report a case of keratoconjunctival chemical injury caused by exposure to EMLA(R) 5% cream.
CASE SUMMARY
A 51-year-old woman presented with ocular pain and decreased visual acuity in her left eye after an autologous fat injection for forehead lifting. At her initial visit, her best corrected visual acuity was 20/40 in the left eye. Slit-lamp examination showed a diffuse corneal epithelial defect and conjunctival injection. Based on history of inadvertent seepage of EMLA(R) 5% cream into the left eye and clinical findings consistent with chemical injury, the patient was treated with antibiotics, steroids, and artificial tears. Two weeks after treatment, several corneal erosions remained, and best corrected visual acuity improved to 20/20. After two months, the corneal and conjunctival epithelia were healed.
CONCLUSIONS
EMLA(R) 5% cream is commonly used as topical anesthetic ointment for dermatologic surgery, including laser procedures. The cream is highly alkaline and can cause chemical injury to the eye, thus extreme caution should be used when applying the cream to the eyelid or face.

Keyword

Alkaline; Chemical injury; Topical anesthetic ointment

MeSH Terms

Anti-Bacterial Agents
Dermatologic Surgical Procedures
Eye
Eyelids
Female
Forehead
Humans
Lifting
Middle Aged
Ophthalmic Solutions
Steroids
Visual Acuity
Anti-Bacterial Agents
Ophthalmic Solutions
Steroids

Figure

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  Figure 1 Slit-lamp photographs of initial presentation showing diffuse conjunctival injection, mild corneal edema (A) and corneal epithelial defect with distinct margin (B). Slit-lamp photographs of conjunctiva showing epithelial defect at 7 o'clock (C) and at 3 o'clock (D) without limbal ischemia.

• 

  Figure 2 At three days after treatment, the left eye presented conjunctival injection and decreased corneal epithelial defect (A). After two weeks, conjunctival injection was nearly disappeared, and there was no epithelial defect in the cornea and conjunctiva. Some corneal erosions remained alone (B). At two months, conjunctival injection and corneal erosions were disappeared (C, D).

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