Salicylic acid
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Salicylic acid Chemical burn to the right eye following accidental application due to confusion: case report
A 59-year-old man had chemical burn to the right eye following accidental application of salicylic acid after confusing it with unspecified eye lubricant [dosage not stated]. The man presented to the emergency department of a hospital in Colombia in 2017 after accidental application of some drops on his right eye. These drops had been manufactured by a laboratory and contained salicylic acid. They were packaged in a plastic dropper bottle and were to be used as antifungal. The accidental application occurred as he confused the bottle with one containing unspecified eye lubricant. He was hospitalised. Upon admission, three hours after the event, palpebral soft oedema, inferior chemosis, and staining in some areas of the bulbar conjunctiva were observed in the affected eye. A central abrasion area of approximately 4 x 4mm was noted in the cornea and the rest of it was covered by a white-grayish membrane of necrotic epithelial tissue. The tarsal conjunctiva was also covered by a similar membrane. Cellularity was observed in the anterior chamber (+) and medium mydriasis. The man was treated with profuse washing and subtotal removal of the corneal and conjunctival necrotic material. He was diagnosed with chemical burn of the ocular surface involving the cornea, limbus, bulbar and tarsal conjunctiva of the right eye secondary to accidental salicylic acid application. He was treated with gatifloxacin, prednisolone, dexamethasone, hyaluronic acid, oxytetracycline, polymyxin B, ascorbic acid and doxycycline. Six hours later, a re-assessment revealed almost total de-epithelisation of the cornea and a membrane of necrotic tissue 360 degrees around the peripheral cornea and the adjacent limbus. The deepithelized area showed very little fluorescein uptake. The absence of epithelium was confirmed following an attempt at debridement of the central area of the cornea with forceps, which evidenced a hardened membrane seemingly corresponding to a Bowman’s membrane with changes in protein coagulation. He had partial limbal insufficiency. Given the severity of the condition, he underwent an emergency surgical procedure the next day with an amniotic membrane graft covering the entire ocular surface and supported by a retention ring made of IV tubing. On the first postoperative day, the retention ring presented displacement and extrusion with the loss of the membrane. Therefore, a new graft was performed with a double amniotic membrane fixed with tissue glue (fibrin sealant) and anchored to the membrane using polypropylene mattress sutures and bolsters. He received autologous plasma enriched with platelet growth factors, bevacizumab and triamcinolone. One week after the burn, he was initiated on 100% oxygen therapy via a face mask. Oxygen application were performed on the right eye with a camera made for that purpose. Twenty days after the burn, the amniotic membrane was noted to have almost completely reabsorbed, with only
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