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Shin and Chung: A Case of Keratoconjunctival Chemical Injury from a Topical Anesthetic Ointment
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(7): 1030-1034.

Published online: 13 July 2012

DOI: https://doi.org/10.3341/jkos.2012.53.7.1030

A Case of Keratoconjunctival Chemical Injury from a Topical Anesthetic Ointment

Jin Hee Shin, MD, Jin Kwon Chung, MD

Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea.

Address reprint requests to Jin Kwon Chung, MD. Department of Ophthalmology, Soonchunhyang University Hospital, #59 Daesagwan-ro, Yongsan-gu, Seoul, Korea. Tel: 82-2-709-9354, Fax: 82-2-710-3196, schcornea@schmc.ac.kr

Received 17 October 2011       Accepted 12 May 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To report a case of keratoconjunctival chemical injury caused by exposure to EMLA® 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® 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® 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.

Keywords: Alkaline, Chemical injury, Topical anesthetic ointment

Figures and Tables

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.
jkos-53-1030-g001
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).
jkos-53-1030-g002

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