Accidental self-induced chemical eye injury in patients with low vision

Sir,

Legislation introduced by the Medicines and Healthcare Products Regulatory Agency in 1995 requires Braille to appear on medication labels and in patient information leaflets.¹ This legislation empowers blind persons with autonomy in the self-administration of drugs. Unfortunately, for those who have low vision but do not require Braille, the same safety provision does not exist.

Contact lens users are often provided with two bottles of solution: one to clean the lenses, the main ingredient usually being hydrogen peroxide, and the other to rinse the lenses. Those with low vision rely on tactile information to differentiate such solutions; however, manufacturers frequently package them in similar sized and shaped bottles. We describe two low vision contact lens wearers with self-induced chemical eye injuries secondary to confusion with contact lens solutions.

Case report

Patient 1, a 79 years old high myope, presented with a painful red right eye after inserting a contact lens that had accidently been rinsed with hydrogen peroxide cleaning solution rather than rinsing solution. Visual acuity was counting fingers in the affected eye. Her left eye was blind secondary to macular degeneration. Ocular examination revealed a grossly injected right eye, corneal oedema, and a large 7 × 7 mm epithelial defect with multiple surrounding punctate epithelial erosions (PEEs).

Patient 2, a 67 years old high myope, presented with bilateral painful red eyes again after wearing contact lenses that had been accidently rinsed with hydrogen peroxide cleaning solution rather than rinsing solution. On examination, visual acuity was 6/18 and 6/12 with glasses in the right and left eye respectively. Both eyes had deeply injected bulbar conjunctiva, multiple scattered corneal PEEs, and evidence of corneal oedema.

Comment

Both patients were unable to differentiate between the two bottles of solution as they are of similar shape, size, and colour (Figure 1). There appears to be a lack of tactile information for persons with low vision with regard to contact lens solutions. We suggest that it is the responsibility of the pharmaceutical provider to ensure that there is a distinct difference in size and shape of packaging for cleaning solutions compared with rinsing solutions, thus ensuring a safety net for low vision patients using contact lenses.

Figure 1

(a, b) Picture illustrating the similarities in shape, size, and design of packaging between the contact lens hydrogen peroxide cleaning solution and the rinsing solution.