Unusual ocular chemical injury from a dental whitening solution

Abstract

Introduction: Accidental ocular burns from the inadvertent use of substances packaged in plastic dropper bottles have been reported for decades and remain a clinical concern, as they may result in severe corneal injury. We report a case of a patient who mistakenly instilled dental whitening drops, causing a serious corneal burn. Prompt, aggressive management resulted in a favorable visual outcome.

Case report: An 11-year-old male patient presented with left eye pain, swelling, and reduced vision after accidentally instilling a drop of dental whitening solution (alkali) instead of Probeta-N (betamethasone 0.1% and Neomycin 0.5%). His mother rinsed the eye immediately and took him to a health facility, where further irrigation and eye drops (cyclopentolate 1%, diclofenac, and gentamicin) were administered before referral to Kenyatta National Hospital (KNH). At KNH, he was diagnosed with a left eye chemical injury (Roper-Hall grade 3) and treated with moxifloxacin 0.5% eye drops, cyclopentolate 1%, prednisolone acetate 1%, artificial tears, oral vitamin C, and a bandage contact lens. Our patient experienced good outcomes; visual acuity was 6/6 after 1 month, and during the first review, the corneal epithelium had fully regenerated. The primary factors influencing these favorable outcomes included timely and adequate irrigation, the amount of the caustic agent, and early presentation to the healthcare facility.

Conclusion: This case highlights the importance of proper labeling, patient education, and careful administration of eye drops to prevent such incidents. Chemical eye injuries due to mistaken use of medications can lead to severe ocular damage, potentially resulting in long-term visual impairment. Early recognition and prompt management are crucial in minimizing complications and preserving vision.