Super Glued Shut

Case:

3-year-old boy presents with super glue in his right eye. He was being watched by his aunt who left the room for 20 min and came back to find him playing with a tube of super glue. He had gotten some on his left cheek, left eyelashes and in his right eye. They had flushed with water at home and were able to get his left eyelid open. On arrival, he is inconsolable in mom’s arms.

 Image 1: Super glued eye. Source: https://metrouk2.files.wordpress.com/2016/11/ad_226649057e1479649086695.jpg?quality=80&strip=all&strip=all

Image 1: Super glued eye. Source: https://metrouk2.files.wordpress.com/2016/11/ad_226649057e1479649086695.jpg?quality=80&strip=all&strip=all

Recommendations from the Super Glue Corporation:

Should Super Glue bond to any body part where acetone should not be applied, such as the lips or eyes, the following steps will help you get out of any sticky situation!

Skin:

Immerse bonded areas in warm, soapy water. Peel or roll skin apart; a spatula or teaspoon handle or even a pencil will help. Remove cured adhesive with warm, soapy water (may take several applications). Fingernail polish remover with an acetone base has also been successful for removal of cured adhesive from skin.

Lips:

If lips are accidentally stuck together, apply a generous amount of warm water and encourage maximum wetting and pressure from saliva from inside the mouth. Peel or roll (do not pull) lips apart. It is almost impossible to swallow the adhesive as a liquid. The adhesive solidifies upon contact with saliva (moisture) and could adhere to the inside of the mouth. Saliva will lift the adhesive in 1-2 days, avoid swallowing the adhesive after detachment.

Eyelid:

In the event that eyelids are stuck together or bonded to the eyeball, wash thoroughly with warm water and apply a gauze patch. The eye will open without further action within 1-4 days. To our knowledge there has never been a documented case of adhesive in the eye causing permanent damage. Do not try to force eyes open.

Eyeball:

The adhesive will attach itself to the eye protein and will disassociate from it over time, usually within several hours. Periods of weeping and double vision may be experienced until clearance is achieved. Use of water to wash eyes repeatedly may assist in aiding more rapid removal of the adhesive.

WE SUGGEST THAT ALL INCIDENTS OF EYE EXPOSURE TO CYANOACRYLATE ADHESIVE (SUPER GLUE) BE DISCUSSED WITH A PHYSICIAN.

ED Management:

In the ED, with a screaming child and nervous parents, you may elect to try and remove the glue rather than patch the eye and send them home.  Article by Danish authors recommends surgical eyelid opening if necessary (specifically for bilateral glued shut), but if easily done in the ED, it makes sense to try and remove the glue and open the eyes.

The Procedure:

1. Calm the patient. Child life Specialists, IN versed, conscious sedation if necessary

2. Gather your supplies

 Image 2: The supplies

Image 2: The supplies

a. Erythromycin ointment (lubricates and loosens the glue)

b. Soft cotton swab

c. 4x4s

d. Paperclips for eyelid holders

e. Tetracaine drops

f. Fluorescein drops and wood’s lamp


3. Numb the eye with Tetracaine drops, put a ribbon of erythromycin on the eyelid

4. Trim the lashes if necessary to open the lid, do not pull the lids apart if they are glued shut

5. Use cotton swab to gently wipe away chunks of glue on the cornea/sclera (it should be mobile and not adherent to the surface of the eye), if adherent to the surface of the eye, do not force it off or your will scratch the cornea

6. Rinse the eyes with saline or water, Morgan lens if cooperative patient

7. Do a thorough woods lamp exam after fluorescein administration

8. Call ophthalmology if you have any complications, adherent glue to the eye surface or shut lids

After ED Care:

1. Erythromycin ointment x 3 days

2. Ophthalmology follow-up

3. Patch if eyelids remain glued shut or glue still adherent to cornea/sclera

Faculty Reviewer: Dr. Chris Merritt

Further Resources on the Topic:

Reddy SC. Superglue injuries of the eye. International Journal of Ophthalmology. 2012;5(5):634-637. doi:10.3980/j.issn.2222-3959.2012.05.18.