- Email: [email protected]
Corneal injury from explosion of microwaved eggs
‘”
‘1’“:
sent &ough integrated services digital’ network lines that shows a postkeratoplasty patient with a persistent epithelial defect. Inset shows simultaneous macroscopic view of the clinic. (B) Fluorescein staining of the ocular surface of the same patient viewed under blue light. Although the resolution of the image is compromised because of the video capturing process from S-VHS tape, green fluorescein dye can be observed that corresponds to the area lacking an intact cornea1 epithelium.
integrated services digital network lines (2 X 64 kilobytes [kbytes] each) for a total transmission capacity of 384 kbytes, which allows for a time resolution of 30 frames per second. One channel (64 kbytes) is reserved for audio signals, while the remaining five channels are used to transmit video signals of either the slit lamp or the video camera mounted on top of the monitor. Both parties have the option of sending slit-lamp images for remote diagnosis or of receiving a macroscopic view of the room for teleconferences between physicians, as well as for interviewing the patient. The clarity of the slit-lamp image (Figure 2A) is of acceptable quality for assessing the ocular surface, and simultaneous audio transmission allows the direct communication between physicians if further clarification is required. Detailed observation of the epithelium by fluorescein staining is also possible (Figure 2B), as is visualization of cells within the anterior chamber, if cooperation by the patient is good. Although finer structures such as the cornea1 endothelium are not visible at this resolution, the macroimage camera and audio transmission are sufficient to relay other necessary information. Because ophthalmology is a field that relies on graphic data, telemedicine using conventional telecommunication infrastructures offers sufficient information to examine patients and diagnose ocular surface disorders. The most important aspect of this 390
system is that the patient is spared the prolonged hospitalization and travel expenses for return visits to the referral center, which would be required without the benefits of telemedicine. REFERENCES Tsubota K, Toda I, Saito H, Shinozaki N, Shimazaki J. Reconstruction of the cornea1 epithelium by limbal allograft transplantation for severe ocular surface disorders. Ophthalmology 1995;102:1486-1496. Tsubota K, Satake Y, Shimazaki J. Treatment of severe dry eye. Lancet 1996;348:123. Tsubota K, Satake Y, Ohyama M, et al. Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens-Johnson syndrome. Am J Ophthalmol 1996;122:38-52. Vaughan B, Took K, Kelly L, Ewing DJ, Andrew LT. A client/server approach to telemedicine. Proc Ainu Swamp Compute Apple Med Care 1995:776-780.
Cornea1 Injury From Explosion of Microwaved
Eggs
Reuben T. Yoo, MD, Pedro M. Rivera, MD, Joseph P. Campbell, MD, and Salim I. Butrus, MD To report two patients with ocular burns from explosion of microwaved eggs that caused direct vision-threatening cornea1 damage. PURPOSE:
AMERICAN JOURNAL OF OPHTHALMOLOGY
MARCH 1998
METHODS: The initial examination and treatment of both patients are described. RESULTS: Both patients were initially examined with severe decrease in the visual acuity of both eyes. The first patient required limbal conjunctival transplantation and a subsequent penetrating keratoplasty in the right eye and prolonged treatment of superficial keratitis in the left eye. The second patient sustained bilateral cornea1 epithelial defects and unilateral intrastromal hemorrhage. CONCLUSIONS: Exploding microwaved eggs can cause notable thermal injury to the eyes. The public should be educated about the dangers of cooking eggs in the microwave oven. (Am J Ophthalmol 1998;125:390-392. 0 1998 by Elsevier Science Inc. All rights reserved.) N RECENT
YEARS,
THERE
HAVE
BEEN
NINE
CASE
RE-
of microwaved eggs causing cornea1 burns. All cases except one were superficial, with complete restoration of vision on short follow* UP* ‘x2 We report two cases of burns to the cornea and ocular adnexa that resulted in prolonged ocular morbidity.
FIGURE 1. Patient 1. Six weeks after injury from exploding egg. Note extensive deep and superficial corneal vascularization of the right eye.
I ports in the literature
CASE I: A lo-year-old girl placed an egg in a bowl and cooked it in a microwave oven for 7 minutes. The egg exploded on removal from the oven, causing second-degree burns to the forehead, malar area, and the eyes. Initial visual acuity was RE, hand motions and LE, 20/50. Biomicroscopic examination disclosed an 80% cornea1 epithelial defect on the right eye, with 3 clock hours of limbal blanching inferiorly. One clock hour of inferior blanching was present on the left cornea, with diffuse superficial punctate keratitis. The patient was treated with polymyxin B/trimethoprim, one drop three times a day, and prednisolone acetate I%, one drop six times a day, to both eyes. At 6 weeks, the left eye had completely healed with restoration of 20/20 visual acuity. The right eye, however, developed superficial and deep cornea1 neovascularization with stromal haze and a persistent visual acuity of hand motions (Figure 1). She underl
Accepted for publication Ott 3, 1997. Washington National Eye Center, Washington Hospital Center. Inquiries to Sahm 1. Butrus, MD, 650 Pennsylvania Ave SE, Ste 270, Washington, DC 20003; fax: (202) 547-4257; [email protected]
VOL.
125,
No.
:3
went an autologous limbal conjunctival graft of the right eye at the 6-o’clock and 12-o’clock positions using tissue obtained from the left eye, resulting in marked regression of the cornea1 vessels. Six weeks postoperatively, the patient’s visual acuity was 20/100 but showed no further improvement because of corneal haze and scarring. The patient subsequently underwent a penetrating keratoplasty 8 months after the initial injury. l CASE Z: A 35year-old woman microwaved two untracked eggs in a cup of water for 14 minutes. The eggs exploded upon removal, causing first-degree to second-degree burns of her face and ocular adnexa. Visual acuity was BE, 20/400. The right cornea showed a total epithelial loss with intracorneal hemorrhage superiorly. The left cornea showed an 8-mmdiameter central epithelial defect. She was treated initially with erythromycin ointment and scopolamine 0.25% drops, three times a day, to both eyes. By day 5, the left eye had nearly resolved, whereas the right cornea showed persistent epithelial defect. Epithelial regrowth did not occur on the right cornea until day 8 (Figure 2). Combination tobramycin/ dexamethasone drops, twice a day, and a bandage soft contact lens were added to the treatment regimen. Final resolution of the epithelial defect occurred on
BRIEF REPORTS
391
Cornea1 Injury After Carbon Dioxide laser Skin Resurfacing Randolf A. Widder, MD, Maria Severin, MD, Bernd Kirchhof, MD, and Giinter Karl Krieglstein, MD To describe a cornea1 injury in both eyes of a patient who had undergone carbon dioxide laser skin resurfacing. METHOD: Case report. RESULTS: A 67Nyearvold woman had severe pain and decreased vision in both eyes after undergoing laser skin resurfacing treatment with a pulsed carbon dioxide laser. Clinical examination disclosed a cornea1 ulcer, a bullous keratopathy, and intrastromal bleeding. After perforating keratoplasty, the histologic examination of the cornea showed signs of thermal injury. CONCLUSIONS: The results of the histologic examination and the onset of symptoms within 24 hours after therapy suggest that the laser applicad tion caused the cornea1 damage. Safety guidelines for this procedure should be reviewed. (Am J Ophthalmol 1998;125:392-394. 0 1998 by Elsevier Science Inc. All rights reserved.) PURPOSE:
FIGURE 2. Patient 2. Eight days after exploding egg injury to the right eye. Note the persistent cornea1 epithelial defect.
day 17. A residual superior pannus remained, and the patient’s visual acuity was RE, 20/50. These cases illustrate the potential for visionthreatening burns caused by exploding microwaved eggs. Rapid heating of contents within the closed compartment of the eggshell or unpierced yolk (even with an open shell) results in an equally rapid rise in pressure.’ These eggs then explode because of turbulence as they are being retrieved from an oven or when the yolk is pierced. ‘j4 Adding to the morbidity is the fact that fluid heated in a microwave oven retains heat for a longer time, as compared with heating in conventional ovens or stoves.5 Ophthalmologists should be aware of this serious risk and caution the public against the dangers of cooking eggs in microwave ovens.
REFERENCES
1, Maley MP. Burns from microwave ovens. Lancet 1986; 1: 1147. 2. Corridan P, Hsyan J, Price NJ, McDonnell PJ. Exploding microwaved eggs. Br Med J 1992;304:1053. 3. Singh J, Shah P, Sutton GA. Exploding eggs. N Engl J Med 1991;325:1749. 4. Bradford GE, Burnstine RA. Exploding eggs. N Engl J Med 1991;325:1749. 5. James MI. Burns from fluid heated in a microwave oven, Br Med ] 1989;298:1452.
392
W
E DESCRIBE
A CORNEAL
INJURY
AFTER
CARBON
dioxide laser skin resurfacing. A 67-year-old woman with severe pain and decreased vision in both eyes was referred to our clinic. Her symptoms had appeared 6 weeks earlier, after a dermatologist performed a skin resurfacing procedure on her entire face using an pulsed carbon dioxide laser. The procedure had been performed initially for cosmetic reasons, with administration of local anesthesia and blockage of the supraorbital, supratrochlear, infraorbital, and mental nerves. Because of pain, general anesthesia was induced. Additionally, dexpanthenol ointment was applied to the cornea. Treatment included the upper and lower eyelids of both eyes. The eyelids were treated with two passes of the laser (250 to 300 mJ; 50 to 60 W; diameter, 6 to 7 mm). For eye protection, Accepted for publication Ott 3, 1997. Department of Ophthalmology, University of Cologne. Inquiries to Randolf A. Widder, MD, Klinik und Poliklinik Autrenbeilkunde der Universimt zu K&t, 50924 Kiiln. Germanv: + ;49-22 l-4347; e-mail: randolf.widder@uni-koelade
AMERICAN JOURNAL OF OPHTHALMOLOGY
fiir fax:
MARCH 1998
‘1’“:
sent &ough integrated services digital’ network lines that shows a postkeratoplasty patient with a persistent epithelial defect. Inset shows simultaneous macroscopic view of the clinic. (B) Fluorescein staining of the ocular surface of the same patient viewed under blue light. Although the resolution of the image is compromised because of the video capturing process from S-VHS tape, green fluorescein dye can be observed that corresponds to the area lacking an intact cornea1 epithelium.
integrated services digital network lines (2 X 64 kilobytes [kbytes] each) for a total transmission capacity of 384 kbytes, which allows for a time resolution of 30 frames per second. One channel (64 kbytes) is reserved for audio signals, while the remaining five channels are used to transmit video signals of either the slit lamp or the video camera mounted on top of the monitor. Both parties have the option of sending slit-lamp images for remote diagnosis or of receiving a macroscopic view of the room for teleconferences between physicians, as well as for interviewing the patient. The clarity of the slit-lamp image (Figure 2A) is of acceptable quality for assessing the ocular surface, and simultaneous audio transmission allows the direct communication between physicians if further clarification is required. Detailed observation of the epithelium by fluorescein staining is also possible (Figure 2B), as is visualization of cells within the anterior chamber, if cooperation by the patient is good. Although finer structures such as the cornea1 endothelium are not visible at this resolution, the macroimage camera and audio transmission are sufficient to relay other necessary information. Because ophthalmology is a field that relies on graphic data, telemedicine using conventional telecommunication infrastructures offers sufficient information to examine patients and diagnose ocular surface disorders. The most important aspect of this 390
system is that the patient is spared the prolonged hospitalization and travel expenses for return visits to the referral center, which would be required without the benefits of telemedicine. REFERENCES Tsubota K, Toda I, Saito H, Shinozaki N, Shimazaki J. Reconstruction of the cornea1 epithelium by limbal allograft transplantation for severe ocular surface disorders. Ophthalmology 1995;102:1486-1496. Tsubota K, Satake Y, Shimazaki J. Treatment of severe dry eye. Lancet 1996;348:123. Tsubota K, Satake Y, Ohyama M, et al. Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens-Johnson syndrome. Am J Ophthalmol 1996;122:38-52. Vaughan B, Took K, Kelly L, Ewing DJ, Andrew LT. A client/server approach to telemedicine. Proc Ainu Swamp Compute Apple Med Care 1995:776-780.
Cornea1 Injury From Explosion of Microwaved
Eggs
Reuben T. Yoo, MD, Pedro M. Rivera, MD, Joseph P. Campbell, MD, and Salim I. Butrus, MD To report two patients with ocular burns from explosion of microwaved eggs that caused direct vision-threatening cornea1 damage. PURPOSE:
AMERICAN JOURNAL OF OPHTHALMOLOGY
MARCH 1998
METHODS: The initial examination and treatment of both patients are described. RESULTS: Both patients were initially examined with severe decrease in the visual acuity of both eyes. The first patient required limbal conjunctival transplantation and a subsequent penetrating keratoplasty in the right eye and prolonged treatment of superficial keratitis in the left eye. The second patient sustained bilateral cornea1 epithelial defects and unilateral intrastromal hemorrhage. CONCLUSIONS: Exploding microwaved eggs can cause notable thermal injury to the eyes. The public should be educated about the dangers of cooking eggs in the microwave oven. (Am J Ophthalmol 1998;125:390-392. 0 1998 by Elsevier Science Inc. All rights reserved.) N RECENT
YEARS,
THERE
HAVE
BEEN
NINE
CASE
RE-
of microwaved eggs causing cornea1 burns. All cases except one were superficial, with complete restoration of vision on short follow* UP* ‘x2 We report two cases of burns to the cornea and ocular adnexa that resulted in prolonged ocular morbidity.
FIGURE 1. Patient 1. Six weeks after injury from exploding egg. Note extensive deep and superficial corneal vascularization of the right eye.
I ports in the literature
CASE I: A lo-year-old girl placed an egg in a bowl and cooked it in a microwave oven for 7 minutes. The egg exploded on removal from the oven, causing second-degree burns to the forehead, malar area, and the eyes. Initial visual acuity was RE, hand motions and LE, 20/50. Biomicroscopic examination disclosed an 80% cornea1 epithelial defect on the right eye, with 3 clock hours of limbal blanching inferiorly. One clock hour of inferior blanching was present on the left cornea, with diffuse superficial punctate keratitis. The patient was treated with polymyxin B/trimethoprim, one drop three times a day, and prednisolone acetate I%, one drop six times a day, to both eyes. At 6 weeks, the left eye had completely healed with restoration of 20/20 visual acuity. The right eye, however, developed superficial and deep cornea1 neovascularization with stromal haze and a persistent visual acuity of hand motions (Figure 1). She underl
Accepted for publication Ott 3, 1997. Washington National Eye Center, Washington Hospital Center. Inquiries to Sahm 1. Butrus, MD, 650 Pennsylvania Ave SE, Ste 270, Washington, DC 20003; fax: (202) 547-4257; [email protected]
VOL.
125,
No.
:3
went an autologous limbal conjunctival graft of the right eye at the 6-o’clock and 12-o’clock positions using tissue obtained from the left eye, resulting in marked regression of the cornea1 vessels. Six weeks postoperatively, the patient’s visual acuity was 20/100 but showed no further improvement because of corneal haze and scarring. The patient subsequently underwent a penetrating keratoplasty 8 months after the initial injury. l CASE Z: A 35year-old woman microwaved two untracked eggs in a cup of water for 14 minutes. The eggs exploded upon removal, causing first-degree to second-degree burns of her face and ocular adnexa. Visual acuity was BE, 20/400. The right cornea showed a total epithelial loss with intracorneal hemorrhage superiorly. The left cornea showed an 8-mmdiameter central epithelial defect. She was treated initially with erythromycin ointment and scopolamine 0.25% drops, three times a day, to both eyes. By day 5, the left eye had nearly resolved, whereas the right cornea showed persistent epithelial defect. Epithelial regrowth did not occur on the right cornea until day 8 (Figure 2). Combination tobramycin/ dexamethasone drops, twice a day, and a bandage soft contact lens were added to the treatment regimen. Final resolution of the epithelial defect occurred on
BRIEF REPORTS
391
Cornea1 Injury After Carbon Dioxide laser Skin Resurfacing Randolf A. Widder, MD, Maria Severin, MD, Bernd Kirchhof, MD, and Giinter Karl Krieglstein, MD To describe a cornea1 injury in both eyes of a patient who had undergone carbon dioxide laser skin resurfacing. METHOD: Case report. RESULTS: A 67Nyearvold woman had severe pain and decreased vision in both eyes after undergoing laser skin resurfacing treatment with a pulsed carbon dioxide laser. Clinical examination disclosed a cornea1 ulcer, a bullous keratopathy, and intrastromal bleeding. After perforating keratoplasty, the histologic examination of the cornea showed signs of thermal injury. CONCLUSIONS: The results of the histologic examination and the onset of symptoms within 24 hours after therapy suggest that the laser applicad tion caused the cornea1 damage. Safety guidelines for this procedure should be reviewed. (Am J Ophthalmol 1998;125:392-394. 0 1998 by Elsevier Science Inc. All rights reserved.) PURPOSE:
FIGURE 2. Patient 2. Eight days after exploding egg injury to the right eye. Note the persistent cornea1 epithelial defect.
day 17. A residual superior pannus remained, and the patient’s visual acuity was RE, 20/50. These cases illustrate the potential for visionthreatening burns caused by exploding microwaved eggs. Rapid heating of contents within the closed compartment of the eggshell or unpierced yolk (even with an open shell) results in an equally rapid rise in pressure.’ These eggs then explode because of turbulence as they are being retrieved from an oven or when the yolk is pierced. ‘j4 Adding to the morbidity is the fact that fluid heated in a microwave oven retains heat for a longer time, as compared with heating in conventional ovens or stoves.5 Ophthalmologists should be aware of this serious risk and caution the public against the dangers of cooking eggs in microwave ovens.
REFERENCES
1, Maley MP. Burns from microwave ovens. Lancet 1986; 1: 1147. 2. Corridan P, Hsyan J, Price NJ, McDonnell PJ. Exploding microwaved eggs. Br Med J 1992;304:1053. 3. Singh J, Shah P, Sutton GA. Exploding eggs. N Engl J Med 1991;325:1749. 4. Bradford GE, Burnstine RA. Exploding eggs. N Engl J Med 1991;325:1749. 5. James MI. Burns from fluid heated in a microwave oven, Br Med ] 1989;298:1452.
392
W
E DESCRIBE
A CORNEAL
INJURY
AFTER
CARBON
dioxide laser skin resurfacing. A 67-year-old woman with severe pain and decreased vision in both eyes was referred to our clinic. Her symptoms had appeared 6 weeks earlier, after a dermatologist performed a skin resurfacing procedure on her entire face using an pulsed carbon dioxide laser. The procedure had been performed initially for cosmetic reasons, with administration of local anesthesia and blockage of the supraorbital, supratrochlear, infraorbital, and mental nerves. Because of pain, general anesthesia was induced. Additionally, dexpanthenol ointment was applied to the cornea. Treatment included the upper and lower eyelids of both eyes. The eyelids were treated with two passes of the laser (250 to 300 mJ; 50 to 60 W; diameter, 6 to 7 mm). For eye protection, Accepted for publication Ott 3, 1997. Department of Ophthalmology, University of Cologne. Inquiries to Randolf A. Widder, MD, Klinik und Poliklinik Autrenbeilkunde der Universimt zu K&t, 50924 Kiiln. Germanv: + ;49-22 l-4347; e-mail: randolf.widder@uni-koelade
AMERICAN JOURNAL OF OPHTHALMOLOGY
fiir fax:
MARCH 1998