1. DR WEI BOON KHOR FRCSED, FAMS CONSULTANT CORNEA AND EXTERNAL EYE DISEASE SERVICE SINGAPORE NATIONAL EYE CENTRE I HAVE NO FINANCIAL INTERESTS IN THE SUBJECT MATTER OF THIS POSTER Chinese Medicated Oil as a Cause of Accidental Chemical Injury to the Cornea : A Case Series

2. Chinese Medicated Oils Are a traditional homeopathic therapy common in Singapore and many parts of Asia These medicated oils are a mixture of essential oils; the composition varies from brand to brand, but common ingredients include  Menthol crystals  Methyl Salicylate  Camphor  Eucalyptus / Peppermint / Lavender oils

3. Chinese Medicated Oils These oils have a characteristic fragrance and are typically sold in small glass bottles They are usually applied to the skin for treatment of headaches, minor cuts, insect bites, etc Examples of Chinese Medicated Oils.

4. Purpose Methods This poster presents a case series of 4 patients with chemical injuries to the cornea due to accidental application of Chinese medicated oil to the eye A retrospective case series of consecutive patients with application of medicated oil to the eye, presenting to a Cornea sub-speciality clinic of a tertiary ophthalmic centre Initial visual acuity, clinical findings, management, complications and final visual acuity were documented Patients were also questioned as to the reasons why the medicated oil was placed into the eye. A Case Series

5. Results Four Asian females with a mean age of 76 years old (range 68-85) were included Each patient had injury to the left eye only All admitted to mistaking the medicated oil for artificial tears, despite the characteristic glass bottles they are sold in Presenting vision in the injured eye ranged between 6/36 (20/120) to count fingers (CF) vision In each case, a total / subtotal epithelial defect was noted with Descemet folds, but with no limbal involvement

6. Results Initial therapy in all cases was irrigation, followed by intensive medical therapy with  preservative-free topical dexamethasone  preservative-free lubricants and gels  prophylactic broad-spectrum antibiotics (eg levofloxacin)  oral Vitamin C supplementation In those patients with slow re-epithelisation, a bandage contact lens was applied to aid recovery and minimise pain Unfortunately, the medicated oil involved was not identified / not documented in all 4 cases The following slides illustrates two of the patients in this series

7. Patient 1 70-year old female was referred to the Ophthalmology service following accidental application of medicated oil onto her left eye Visual acuity on presentation was CF at 1 metre Examination showed a total epithelial defect, Descemet membrane folds, but no limbal ischaemia. Intraocular pressure was within normal range Medical therapy was initiated the same day The epithelial defect healed after 2 weeks, with central sub-epithelial haze; visual acuity was 6/36 (20/120) The sub-epithelial haze took another 2 week to resolve; final best corrected vision was 6/9 (20/30) at the final visit

8. Slit lamp photographs of the left eye of Patient 1

9. Patient 4 A 76-year-old female presented to the service with redness and decreased vision in the left eye; this was 3 days after accidental instillation of medicated oil to the left eye for “eye irritation” Pain was reported to be minimal; vision was 6/60 (20/200) There was a subtotal epithelial defect with no limbal ischemia Decreased cornea sensation was also noted

10. Slit lamp photographs of the left eye of Patient 4

11. Case 4 After a week of therapy, re-epithelisation remained poor; a bandage contact lens was applied After a second week of treatment, a dendritic epithelial defect with terminal bulbs was noted; the contact lens was removed and topical dexamethasone was stopped The presumed herpetic ulcer resolved with the use of topical acyclovir ointment 5x/day for one week Final visual acuity was 6/7.5 (20/25) with the dendrite leaving a faint sub-epithelial scar

12. Discussion Chinese medicated oils can result in significant chemical burns to the corneas, although none of our patients developed limbal ischemia nor cicatricial changes to the conjunctiva All our patients made a full recovery with medical therapy alone, but required between 2-4 weeks of treatment All our patients were from an older demographic  This may have contributed to them mistaking the oil for artificial tears  Admission may be required for those with poor social support  Age may have contributed to delayed re-epithelisation, and the need for prolonged treatment Manufacturers of medicated oils should consider a prominent label on bottles, in order to warn users not to use these products in the eye Questions or comments? khor.wei.boon@snec.com.sg