Eye injury with mercuric chloride.

Abstract

With the advent of modern ophthalmic treatment the use of mercury preparations in ophthalmology has almost been relegated to past history, but mercurous chloride (calomel) is still occasionally used as an insufflation into the eyes, especially in such conditions as phlyctenular keratoconjunctivitis. Recently we saw a case wherein mercuric chloride (HgCl2) was mistaken for calomel and dusted into the right eye of a young woman suffering from phlyctenular keratoconjunctivitis with disastrous results. Case reportA 1g-year-old married woman came to the eye out-patients department on September I 6, I 97 I, of Snowden Hospital, Simla, with the complaint ofphotophobia and the presence of a nodule at the lower limbus of the right eye of one week's duration. The junior casualty officer noted a large phlycten at the limbus at the 6 o'clock position and inadvertently dusted mercuric chloride into the eye after putting in a drop of xylocaine.The patient immediately complained of severe pain in the eye and although the eye was thoroughly flushed with normal saline within a minute the whole cornea became opaque, and the conjunctiva, especially on the globe, lost its lustre and became whitish with widespread necrosis.The eye was dressed with atropine I per cent. and hydrocortisone eye ointment and the patient was admitted to hospital. Within 2 hours gross oedema of the lids necessitated examination with lid retractors (Fig. I). The conjunctiva was extensively necrosed and blanched and in places markedly chemosed and ballooned, thus hiding the cornea, which was oedematous, cloudy, and denuded of epithelium; the anterior chamber, iris, pupil, lens, and fundus could not be seen because of the opaque cornea.The patient was given oral prednisolone IO mg. 4-hrly and chloramphenicol 250 mg. 6 hrly. Betamethasone eye drops were given hourly, with atropine, terramycin, and cortisone eye ointment every 4 hours.By the evening the pain was relieved and the palpebral and conjunctival oedema became a little less. By next morning the oedema was considerably less while the cornea showed signs of clearing (Fig. 2). The frequency of local corticosteroid drops was reduced to six times a day while the rest of the regime was continued.