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Acetone Used as a Solvent in Accidental Tarsorrhaphy
136
AMERICAN JOURNAL O F
OPHTHALMOLOGY
T h e Directors of the Ophthalmic Publishing Company dedicated a special issue of the American Journal of Ophthalmology to Mike in September of 1 9 7 5 , and the barest outline of his career is presented there. What cannot be reflected are his friendship, stimulating companionship, and the wise counsel he always provided. Truly, he will be missed. F R A N K W. N E W E L L
For 3 5 years M i k e Hogan and his family have been our close friends. It is hard to accept the loss of so vital, optimistic, knowledgeable, and useful a man. However, Mike would not want us to mourn. Rather, we should celebrate the busy, useful, and joyful life of a man who has enriched ophthalmology and the lives o f those who have come in contact with him. H e lives on in his Department of Ophthalmology, in his ideas and writings, and in the hearts of his family and of his many students and friends. R O B E R T N. S H A F F E R
JANUARY, 1977
residents in ophthalmology, research assistants, and faculty members; and a very dear friend. Soft spoken and extremely gentle in demeanor, M i k e nevertheless exuded strength and confidence. Although obviously a busy, highly productive man, he never seemed overly burdened by his responsibilities. I once had the pleasant privilege of being a house guest o f the Hogans for a month while finishing the manuscript for our book. T h a t gave m e a unique opportunity to observe and appreciate even better Mike's sincerity and friendliness, his broad cultural interests, his stamina and athletic abilities, and his wonderful home and family. Hiss loss creates a great void within the profession and an even greater emptiness within the family. Let us hope the knowlege that they were so much more fortunate than most to have had such a remarkable head will give Mike's family the courage and strength to go on without him. All of us who ever came under his influence are better people because of it. LORENZ E . ZIMMERMAN
Ophthalmology has lost one of the giants of the present generation. I can think of no one person who has been more intimately involved in so many different clinical, surgical, investigative, educational, authorial, administrative, and organizational aspects of modern ophthalmology than was Mike Hogan. While perhaps most widely recognized for his senior authorship of the modern bibles of ophthalmic pathology and ocular histology, " U n c l e M i k e " was also the highly respected primary consultant for innumerable practitioners in the San Francisco B a y area; the acknowledged team leader for many research projects pursued at the Proctor Foundation and at the University of California; the beloved mentor for untold numbers of medical students,
CORRESPONDENCE Letters to the Editor must be typed double-spaced on 8V2 x 11-inch bond paper, with 1'/2-inch margins on all four sides, and limited in length to two manuscript pages.
Acetone U s e d As A Solvent in Accidental Tarsorrhaphy Editor: After reading the article, "An accidental tarsorrhaphy caused by acrylic a d h e s i v e " (Am. J . Ophthalmol. 8 2 : 5 0 1 , 1 9 7 6 ) by Alvan Baient, I wish to inform the readers of another alternative to the solvent men-
VOL. 83, NO.
1
137
CORRESPONDENCE
tioned in the report: acetone is more readily obtained and less toxic than nitromethane. I have used acetone three times in the last 18 months to release accidental eyelid adhesions without sequelae. Case 1—A 35-year-old woman was using Superglue and accidentally obstructed the tube's delivery end. F o r c i n g it open, she split the tube, propelling glue at her left eye and onto her fingers. Her fingers fused together and her upper and lower eyelids fused 4 mm below the cilia line. T h e finger adhesions were dissolved with acetone without sequelae. I used cotton-tipped applicators soaked with acetone to release the eyelid without any subsequent sequelae. Case 2—A 10-year-old boy was constructing plastic models and accidentally dropped the acrylic glue, causing the material to spurt at his right eye. T h e child attempted to wipe it away with his hand. His father used acetone to release the child's fingers from his right eyelid but the right eyelids would not separate. T h e skin above the upper lashes was fused to a similar area below, causing inversion o f both eyelids. I released the eyelids by using applicators and acetone. Case 3—An 8-year-old boy had Krazy Glue thrown at his right eye. T h e cilia were fused together in the upper and lower eyelids. Acetone and applicators were used to Iyse the adhesion. T h e cilia were sacrificed distally rather than attempting to free them further. When the glue was removed, there was an area of conjunctival abrasion where it had seeped into the eye. Immediate follow-up revealed no sequelae. T h e third case occurred three days after I read the article. T h u s , I was surprised at both the supposed rarity of this occurrence and the lack of mention of acetone as a solvent. I have seen no evidence o f tissue toxicity from this mode of therapy. However, I believe that using acetone in a
drop form may cause effects similar to those described by Dr. Baient within the cul-de-sacs. In addition I wish to relate a personal episode with Krazy Glue. W h i l e repairing some machinery in the office I accidentally glued two of my fingers to the instrument. All adhesions were easily broken with acetone without any tissue sequelae. A L A N M. M I N D L I N ,
Pontiac,
M.D.
Michigan
Temporary Tarsorrhaphy Editor: Our first experience with a case of accidental tarsorrhaphy caused by acrylic adhesive prompted its widespread publicity in the French-and-English-language papers o f Montreal, Oct. 2 4 , 1974, warning parents of the inadvisability of allowing the ir children to handle s uch highly dangerous adhesives, packaged in plastic containers which may be expressed from the nozzle like a jet toward the eye. W e could feel the freely m o b i l e globe under the closed eyelids and thus left desquamation and nature to take their course. T h e eyelids remained firmly closed for just over two weeks. T h e r e was no residual ocular damage, and this has prompted us to use the material described by Dr. Baient for performing temporary tarsorrhaphies. This has proven to be extremely useful. We stick the eyelashes o f the upper eyelid down onto the cheek as he described and then more firmly unite the eyelids by pulling down the skin of the upper eyelid. W e have now used this on 2 4 patients with keratitis either from corneal anesthesia or facial paralysis. I would, therefore, like to emphasize Dr. Balent's point about the usefulness o f this type of tarsorrhaphy in cases where a permanent tarsorrhaphy is not required. T . H. K I R K H A M , F . R . C . S .
Montreal,
Quebec
AMERICAN JOURNAL O F
OPHTHALMOLOGY
T h e Directors of the Ophthalmic Publishing Company dedicated a special issue of the American Journal of Ophthalmology to Mike in September of 1 9 7 5 , and the barest outline of his career is presented there. What cannot be reflected are his friendship, stimulating companionship, and the wise counsel he always provided. Truly, he will be missed. F R A N K W. N E W E L L
For 3 5 years M i k e Hogan and his family have been our close friends. It is hard to accept the loss of so vital, optimistic, knowledgeable, and useful a man. However, Mike would not want us to mourn. Rather, we should celebrate the busy, useful, and joyful life of a man who has enriched ophthalmology and the lives o f those who have come in contact with him. H e lives on in his Department of Ophthalmology, in his ideas and writings, and in the hearts of his family and of his many students and friends. R O B E R T N. S H A F F E R
JANUARY, 1977
residents in ophthalmology, research assistants, and faculty members; and a very dear friend. Soft spoken and extremely gentle in demeanor, M i k e nevertheless exuded strength and confidence. Although obviously a busy, highly productive man, he never seemed overly burdened by his responsibilities. I once had the pleasant privilege of being a house guest o f the Hogans for a month while finishing the manuscript for our book. T h a t gave m e a unique opportunity to observe and appreciate even better Mike's sincerity and friendliness, his broad cultural interests, his stamina and athletic abilities, and his wonderful home and family. Hiss loss creates a great void within the profession and an even greater emptiness within the family. Let us hope the knowlege that they were so much more fortunate than most to have had such a remarkable head will give Mike's family the courage and strength to go on without him. All of us who ever came under his influence are better people because of it. LORENZ E . ZIMMERMAN
Ophthalmology has lost one of the giants of the present generation. I can think of no one person who has been more intimately involved in so many different clinical, surgical, investigative, educational, authorial, administrative, and organizational aspects of modern ophthalmology than was Mike Hogan. While perhaps most widely recognized for his senior authorship of the modern bibles of ophthalmic pathology and ocular histology, " U n c l e M i k e " was also the highly respected primary consultant for innumerable practitioners in the San Francisco B a y area; the acknowledged team leader for many research projects pursued at the Proctor Foundation and at the University of California; the beloved mentor for untold numbers of medical students,
CORRESPONDENCE Letters to the Editor must be typed double-spaced on 8V2 x 11-inch bond paper, with 1'/2-inch margins on all four sides, and limited in length to two manuscript pages.
Acetone U s e d As A Solvent in Accidental Tarsorrhaphy Editor: After reading the article, "An accidental tarsorrhaphy caused by acrylic a d h e s i v e " (Am. J . Ophthalmol. 8 2 : 5 0 1 , 1 9 7 6 ) by Alvan Baient, I wish to inform the readers of another alternative to the solvent men-
VOL. 83, NO.
1
137
CORRESPONDENCE
tioned in the report: acetone is more readily obtained and less toxic than nitromethane. I have used acetone three times in the last 18 months to release accidental eyelid adhesions without sequelae. Case 1—A 35-year-old woman was using Superglue and accidentally obstructed the tube's delivery end. F o r c i n g it open, she split the tube, propelling glue at her left eye and onto her fingers. Her fingers fused together and her upper and lower eyelids fused 4 mm below the cilia line. T h e finger adhesions were dissolved with acetone without sequelae. I used cotton-tipped applicators soaked with acetone to release the eyelid without any subsequent sequelae. Case 2—A 10-year-old boy was constructing plastic models and accidentally dropped the acrylic glue, causing the material to spurt at his right eye. T h e child attempted to wipe it away with his hand. His father used acetone to release the child's fingers from his right eyelid but the right eyelids would not separate. T h e skin above the upper lashes was fused to a similar area below, causing inversion o f both eyelids. I released the eyelids by using applicators and acetone. Case 3—An 8-year-old boy had Krazy Glue thrown at his right eye. T h e cilia were fused together in the upper and lower eyelids. Acetone and applicators were used to Iyse the adhesion. T h e cilia were sacrificed distally rather than attempting to free them further. When the glue was removed, there was an area of conjunctival abrasion where it had seeped into the eye. Immediate follow-up revealed no sequelae. T h e third case occurred three days after I read the article. T h u s , I was surprised at both the supposed rarity of this occurrence and the lack of mention of acetone as a solvent. I have seen no evidence o f tissue toxicity from this mode of therapy. However, I believe that using acetone in a
drop form may cause effects similar to those described by Dr. Baient within the cul-de-sacs. In addition I wish to relate a personal episode with Krazy Glue. W h i l e repairing some machinery in the office I accidentally glued two of my fingers to the instrument. All adhesions were easily broken with acetone without any tissue sequelae. A L A N M. M I N D L I N ,
Pontiac,
M.D.
Michigan
Temporary Tarsorrhaphy Editor: Our first experience with a case of accidental tarsorrhaphy caused by acrylic adhesive prompted its widespread publicity in the French-and-English-language papers o f Montreal, Oct. 2 4 , 1974, warning parents of the inadvisability of allowing the ir children to handle s uch highly dangerous adhesives, packaged in plastic containers which may be expressed from the nozzle like a jet toward the eye. W e could feel the freely m o b i l e globe under the closed eyelids and thus left desquamation and nature to take their course. T h e eyelids remained firmly closed for just over two weeks. T h e r e was no residual ocular damage, and this has prompted us to use the material described by Dr. Baient for performing temporary tarsorrhaphies. This has proven to be extremely useful. We stick the eyelashes o f the upper eyelid down onto the cheek as he described and then more firmly unite the eyelids by pulling down the skin of the upper eyelid. W e have now used this on 2 4 patients with keratitis either from corneal anesthesia or facial paralysis. I would, therefore, like to emphasize Dr. Balent's point about the usefulness o f this type of tarsorrhaphy in cases where a permanent tarsorrhaphy is not required. T . H. K I R K H A M , F . R . C . S .
Montreal,
Quebec