Posters

Potassium permanganate granules ocular injury in a child

Poster Details

First Author: C.Chirapapaisan THAILAND

Co Author(s):    P. Tantuwanit   S. Srivannaboon   V. Roongpoovapatr        

Abstract Details

Purpose:

To present a rare case of accidental ocular injury of potassium permanganate granules.

Setting:

Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Methods:

A 2-year-old boy presented with screaming from pain on right eye, tearing, inflamed eyelids and brownish stain on fingers. The chemical ocular injury was suspected. The initial management was thorough eye irrigation with normal saline 4000ml. The exposed ocular surface and the fornix were checked with the universal indicator, the pH revealed 7.0. An inferior fornix was noticeably having diffuse brown splotches. The complete eye exam was performed in the operating room. The 5mm epithelial defect (ED) was reveled at the central cornea with no stromal haze. The inferior limbus showed slight blanching. There were some semi-dissolved granules of potassium permanganate (KMnO4) trapped in the inferior fornix over the stained conjunctiva. During chemical agent removal, some burning tissue was desquamated. We tried to clean up the fornix but be aware of preserving the adjacent tissue. Next day, the ED was almost closed. The entire bulbar and tarsal conjunctiva turned mildly injected without any brownish blotch. Fluorescein was stained dispersedly along the inferior fornix and pseudomembrane was produced. On second day, the membrane had transformed into adhesion. So we immediately lysed the adhesion followed by Prokera application to promote wound healing and prevent symblepharon formation. The condition was improved subsequently.

Results:

Corneal clarity was still preserved. There was no epithelial defect over the ocular surface. The conjunctiva turned normal with no fluorescein staining. The fornix was maintained with no symblepharon.

Conclusions:

Potassium permanganate (KMnO4) granules ocular injury was a rare condition. Most of cases were injured by the dissolves solution. In this case, it was an accident of a child who was innocently playing with the granules of KMnO4. Although the chemical agent seemed completely removed, the pH returned to normal and no remaining mucosal stain, the reaction of high concentrated chemical agent was still affected to the ocular surface. The burning response in a child was usually intense and easily develops symblepharon. The prudent observation and aggressive treatment are necessary to prevent long-term complications. FINANCIAL INTEREST: NONE