contact lens case reports
The Ultimate Lid-Attached Contact Lens
BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ, FAAO
In 1998, Ethicon released a new tissue adhesive called Dermabond. This adhesive has since replaced sutures as the treatment of choice for many facial lacerations. With a viscosity similar to water, there is always concern for inadvertent ocular exposure.
A Sticky Situation
Patient B.A. is a 30-year-old male whom we fitted with a cosmetic soft contact lens approximately five years ago. Recently he suffered a laceration to his forehead that was repaired with Dermabond (Figure 1). Some of the adhesive from his forehead ran over onto his left eye and eyelashes. He was relatively free of pain due in part to the presence of his soft contact lens, which was now glued to his upper lid (Figure 2). At this time the patient was referred to our clinic.
Figure 1: Patient B.A with forehead laceration.
Figure 2: Lens glued to upper lid.
Under the operating microscope, the eyelids were gently forced open, with the lower eyelid pulling free first. The upper eyelid was then slowly teased open and inverted. We repeatedly used acetone-soaked cotton swabs to tease the temporal edge of the adhesive cast containing the superior and inferior lashes (Figure 3).
Acetone is generally more effective than mechanical removal of cyanoacrylate adhesive such as Dermabond or Super Glue from the lids and/or cornea. Acetone is deleterious to the corneal epithelium, but it does not permanently damage the stroma. Once the glue was removed, residual acetone was thoroughly irrigated from the eye with a sterile solution. A superficial corneal abrasion was the only adverse effect other than the loss of most of the lower lashes (Figure 4).
Figure 3: Following acetone application, the glue is teased free.
Figure 4: Dermabond cast with embedded lashes.
Management of Adhesive Exposure
If ocular pain is present, manually open the eyelids as soon as possible to prevent ocular trauma. First, soften the glue with warm water, mineral oil or acetone. Then, grasp the edge of the glue with forceps while pulling the skin away with your finger, much like removing adhesive tape from the skin. Once the base is loosened, cut the lashes with scissors.
If the patient is free of pain, apply warm water soaks or mineral oil-saturated pads for 12 to 24 hours. This can break the adhesive and preserve the lashes.
Patrick Caroline is an associate professor of optometry at Pacific University and an assistant professor of ophthalmology at the Oregon Health Sciences University.
Mark André is director of contact lens services at the Oregon Health Sciences University.