To the Editor: We are concerned about the recent number of patients presenting to our hospital after accidentally applying superglue to their eyes. Of the four cases in February and March 2004, two arose from patients mistaking cosmetic nail adhesive for their regular ocular lubricant, and applying it to the inferior ocular fornices, creating a tarsorrhaphy.

Superglues are cyanoacrylate derivatives. Those used domestically are lower-alkyl derivatives than those designed for medical use and have higher tissue toxicity.

The two patients who mistook nail glue for ocular lubricant both required surgical separation of the upper and lower eyelids, and both had significant corneal abrasions, periocular dermatitis and temporary loss of lashes as a result of the reparative surgery. Both were treated with chloromycetin ointment until the abrasions had healed.

We examined the bottles containing the nail adhesives. They were remarkably similar to many ocular lubricant bottles, with no significant difference in size, colour or feel (Box). As both products are often kept together in a cosmetics area of the bathroom, accidental ocular application can occur. Similar cases have been reported in other countries over the past 20 years.1-3

The risk of accidental ocular (or potentially aural) application could be reduced by changes to bottles containing superglue, including:

• childproof cap to prevent conventional opening of the bottle;

• colour coding of the bottles;

• different bottle shape; and

• distinctive odour and/or colouring of the glue.

Superglue and eye lubricant bottles

Examples of bottles of synthetic nail adhesive (two on left) and eye lubricant (two on right), showing similar appearance and feel.