Eye injury from toxic chemical mistaken for eye drops

A 49-year-old man, with a history of occasional red eye self-treated with over-the-counter naphazoline eye drops, accidentally self-administered a drop of “fibreglass resin catalyst”, containing concentrated (approximately 33%) methyl ethyl ketone peroxide (MEKP), to his left eye. The MEKP bottle was purchased at a local hardware store. The patient had previously placed the MEKP bottle on his bedside table and mistook it for his regular eye drops the following morning. Upon instillation, he felt immediate pain and irrigated his eye with water at home before presenting to the emergency department (ED). After appropriate ED irrigation and treatment, he was managed in the hospital’s ophthalmology department. After 13 days, his cornea had healed and his vision had returned to normal. However, there was residual evidence of limbal ischaemia — a poor prognostic sign in ocular chemical injuries.1,2

Ocular chemical injuries are a major source of preventable morbidity and blindness. Strongly oxidative compounds, such as MEKP, especially at high concentrations, cause rapid oxidative damage to corneal epithelium leading to cell death.3 MEKP in particular has been associated with long term symptoms and ocular surface dysfunction in patients who delay primary irrigation.4

The injury reported herein was particularly deleterious as it involved the direct administration of MEKP to the eye, because the patient mistook it for his regular eye drops (Box). This confusion was due to the similar packaging of MEKP to many common eye drops used in ophthalmology. Similar injuries have been reported previously in the literature4 in patients who mistook MEKP for their regular eye drops. Often, patients’ underlying vision is poor, making it difficult for them to differentiate the products without careful inspection.4,5

Packaging MEKP in this medically familiar format poses a significant danger to the general public. We urge manufacturers to reconsider the presentation of this product by obvious colouring of the entire bottle (eg, bright orange with a black lid) so it is impossible to mistake MEKP for regular eye drops. Such a change could significantly reduce the number of preventable vision-threatening injuries sustained in this manner.

Box – Package similarity between naphazoline eye drops (left) and methyl ethyl ketone peroxide (right) bottles