Sir,

We report a novel technique of topical eyelid anaesthesia to permit treatment of ocular superglue injury in a child, thereby avoiding the need for general anaesthetic.

Case report

A five-year-old girl presented to Ophthalmic A&E 1 h following accidental instillation of cyanoacrylate nail bonder into her right eye. The eyelids were completely glued together. The globe could not be seen but was felt to be mobile. After discussion with the mother, an initial attempt at cutting the eyelashes was made, but the lashes could not be trimmed to less than 3 mm as this caused discomfort (Figure 1a). As a result, tetracaine 4% gel (Ametop, Alcon Laboratories (UK) Ltd, Hemel Hempstead, UK) was applied onto the upper and lower eyelids (Figure 1b). After 15 min, there was adequate eyelid anaesthesia for the eyelashes of the lower lid to be cut one-by-one at their base using Vannas scissors with the child awake and supine. This allowed the eye to open completely revealing no corneal damage (Figure 1c). She was treated with oc dexamethasone/neomycin/polymyxin B (Maxitrol, Smith & Nephew Healthcare Ltd, Hull, UK) q.i.d. for a week and made a full recovery (Figure 1d).

Figure 1
figure 1

(a) Initial superglue tarsorrhaphy after trimming of lashes to 3 mm. (b) Tetracaine gel was applied to both upper and lower lids. (c) This provided sufficient anaesthesia so that the lower eyelashes could be cut at their bases and the eyelids separated. (d) The patient at follow up, a month later, showing re-growth of the lashes.

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Comment

Several reports of superglue (cyanoacrylate) causing ocular injury have been documented over the last three decades.1, 2 Cyanoacrylate adheres most strongly to dry surfaces such as the eyelid margins and the eyelashes. This can cause the lids to rapidly bind shut, termed a ‘superglue tarsorrhaphy’, making examination and irrigation impossible.2 Conservative management is often adopted as the glue spontaneously comes off within a week.3 In younger children, however, there is a concern that unilateral visual deprivation for that period may cause amblyopia, and therefore cutting the lashes and separating the eyelids has been recommended.1, 4 Unfortunately this is poorly tolerated by children and often requires a general anaesthetic.1, 4

Topical skin anaesthetics such as tetracaine gel are widely used in paediatrics, and similar formulations such as lidocaine/prilocaine 5% (EMLA) have also been used safely in eyelid surgery.5 To our knowledge, this is the first report of this type of treatment for superglue tarsorrhaphy. This simple and well-tolerated anaesthetic technique has the potential for avoiding the need for a general anaesthetic if waiting for spontaneous opening is not considered appropriate.