Storing e-cigarette liquid next to eye drops caused one woman to mix them up, leading to slight eye damage that could have been much worse, Scottish doctors report.
Since the bottles looked similar at a glance, and the nicotine-laced liquid carried no warnings about the harm of contact with the eyes, the authors of a case report in JAMA Opthalmology say e-cigarette users should be aware of this risk.
The researchers describe a patient in her 50s who presented to the Tennent Institute of Ophthalmology at Gartnavel General Hospital in Glasgow with eye irritation. She had recently been prescribed antibiotic drops for bacterial conjunctivitis, or pinkeye, and stored these next to her e-cig refill liquid in her bathroom cupboard.
When she mistakenly dripped e-cig liquid in her eye she immediately experienced pain, redness and blurred vision. She flushed the eye with water and went to emergency eye services. According to chemical tests, her e-cig liquid had a pH of 6, more acidic than tears, which usually have a pH of about 7.0 to 7.3.
By the time the woman was tested in the hospital, her eye pH was 7.0, which the doctors credited to her having rinsed her eye immediately. Her cornea was stained but there was no damage to the delicate epithelial cells of the eye.
The researchers did not find any other reported cases of people putting e-cigarette liquid in their eyes, but there have been similar accidents with nail glue or olbas oil, which is used to remedy nasal congestion, they write.
"There have been increasing reports of severe ocular injury (including globe rupture) from e-cigarette explosions, both in the eye literature and in the mainstream media," said coauthor David Lockington of Gartnavel General Hospital. "As far as we know, inadvertent administration of E-Cig liquid to the eye instead of eyedrops has not been previously reported in the ophthalmic journals," he said by email.
In this case, the patient only experienced superficial ocular surface damage, which resolved with treatment, he said. "Our patient had a good outcome from this unfortunate incident, with no long term damage to her ocular surface or vision, because she immediately washed out her eye as soon as she realized her mistake, and so limited the potential damage," Lockington said.
Emergency management of any chemical injury to the eye is immediate irrigation and to seek help, he said.
"This is a disturbing report, and it is fortunate that it happened in a bathroom where she had access to running water," said biochemist Irina Stepanov of Masonic Cancer Center at the University of Minnesota in Minneapolis, who was not involved in the report.
Though the similarly shaped bottles were misleading, regardless of their shape, medical products like antibiotic drops should be stored away from any potentially similar products like nail glue, Lockington said.
"There is no warning information on the side of these e-cig liquid bottles or in the product information regarding the potential danger of a chemical injury to the eyes, or the emergency treatment," he said. "This is an oversight which should be addressed by the industry."
