Dr Christopher Go1, Dr Philomena McNamara1, A.Prof Nitin Verma1
1Royal Hobart Hospital, Hobart, Australia
Cyanoacrylate has been used in the management of corneal perforations since 1968. Cyanoacrylate’s side effects are well documented in animal experiments and clinical case reports including instillation into the anterior chamber. We report a case of severe acute anterior chamber inflammation with hypopyon formation following corneal instillation of cyanoacrylate. To our knowledge, this is the first reported case of hypopyon formation resulting from cyanoacrylate toxicity in the literature.
A 48 year old male was referred by a private ophthalmologist for a left 0.2mm paracentral perforation with a 5 year history of bilateral peripheral ulcerative keratitis of unknown cause. He has been treated with long-term QID topical fluorometholone acetate and ofloxacin for over 1 year and has a resultant white cataract. He also has significant atopy from hyper-IgE managed by the dermatologist with mycophenalate and is on patanol to minimise exacerbation of PUK. This patient was managed with cyanoacrylate via a syringe in emergency with bandage contact lens and hourly topical antibiotics. 36 hours later, he was found to have a 1mm hypopyon with 4+ AC activity. This resolved gradually over 1 week and there was no growth on both his vitreous and AC tap.
Given the negative taps, the authors believe this was a reactive response to cyanoacrylate from either; inadvertent entry into the anterior chamber from the application technique, or a severe inflammatory response given the patient’s significant atopic profile. This case report reminds clinicians of the synthetic non-biodegradable nature and toxicity profile of cyanoacrylate and the importance to follow the recommended patch technique by Vote to maximises superficial application only. Also, clinicians should consider the biodegradable fibrin glue if there is a significant history of atopy.
Philomena McNamara is a PGY 3 unaccredited ophthalmology registrar Royal Hobart Hospital. She completed her internship and residency at the Wollongong Hospital after studying medicine at the University of Sydney.