L&T: Through My Lens

Aug
2006

Offering Patients a Destination Experience

Inadvertent adhesion of the lids following accidental cyanoacrylate (Superglue) or other adhesive exposure can be a very alarming situation for patients, especially in the pediatric population.

One technique that has been used to reopen the lids is to manually apply opposite vector forces to break apart the adhesion. However, this technique has several disadvantages. The physician may have to apply quite forceful pressure to break the adhesions. Tissue stretch can diminish the effective separation force at the site of adhesion. Often, the patient is tearing, and the physician is unable to obtain a firm purchase on the eyelids. The maneuver is not always successful and can be uncomfortable to the patient. Another technique to separate adhered eyelids that has been described is to use scissors to cut through the adhesion.

New Maneuver
We prefer a maneuver that can be easily and safely performed. With a motion similar to the Nagahara horizontal phaco chop, we utilize a Jameson muscle hook, which resembles a giant phaco chopper and features a blunt, polished, rounded end.

After inadvertent exposure to adhesive and subsequent adherence of the lid margins, there is often a sufficient gap to pass the distal end of the Jameson muscle hook through.

By pulling the hook parallel to the lid margin through the site of adhesion, as in horizontal phaco chop, the adhesive bond can be broken. The cleavage force is placed directly at the site of adhesion. At no time do we place a sharp instrument near the eye.

Technique
A drop of topical anesthetic is instilled in the involved eye. Upon inspection, there is often an opening between the upper and lower lid. The blunt end of the Jameson hook is passed through this gap in the lid fissure. After rotating the muscle hook such that the distal element of the hook is normal to the surface of the eye, the hook is pulled parallel to the lid margins and through the site of adhesion. Applying sufficient pressure at the site of adhesion easily cleaves the bond. It is often helpful to apply counterpressure with the fellow hand, opposite the motion of the muscle hook. Trim residual glue from the eyelashes or around the eyelid with blunt- tip scissors. Any remaining glue will slough off within several days. 

Dr. Yee is an assistant professor of ophthalmology at the University of Alabama-Birmingham. Dr. Austin is a third-year resident there.

 

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