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Topical disinfectant Potassium Permanganate causes accidental severe ocular Injury- case report

Written By : Dr Manoj Kumar Nayak |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-10-16T09:30:01+05:30  |  Updated On 18 Oct 2021 11:37 AM IST
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Accidental severe ocular injury by Potassium Permanganate (KMnO4)- 1st case report

Potassium permanganate (KMnO4) is a common topical disinfectant, astringent and antiseptic agent used in dermatology. It is normally used in a dilution of 0.01- 0 .0001%. If used in higher concentration it can cause severe chemical irritation and burning of skin. Recently a report describing a unique case of accidental ocular injury in a 6 year old female child by potassium permanganate crystals was described in the Indian Dermatology Online Journal.

A 6‑year‑old girl was brought by her father with severe pain, redness, and swelling of right eye. The child opened the box of KMnO4 crystal which his father was using for his acute eczema, while playing and accidentally the loose crystals fell inside her eye. Her vitals were stable with no signs of systemic toxicity. Brown staining was observed over the tongue and neck. Copious irrigation of the eye was done with a balanced salt solution for 30 mins. Balanced saline solution is a sterile cleansing solution that provides the cells with water and inorganic ions while maintaining a physiological pH and osmotic pressure. The loose impacted crystals were removed from the inferior fornix with the help of sterile cotton buds. The staining of neck and tongue was cleaned with normal saline.

After removal of the debris, her visual acuity was 6/24. Slit‑lamp examination revealed stained and congested conjunctival mucosa. According to Dua classification, there was more than 30% of conjunctival involvement and more than 3‑6 clock hours of limbal involvement (Grade III). The patient was put on 0.5% moxifloxacin eye drops 4 times a day, 1% prednisolone eye drops every 2 hours for the initial 10 days to reduce inflammation, and lubricant eye drop hourly. Along with this, the patient also received tablet vitamin C 500 mg three times a day.

Gradually, all KMnO4 stains had disappeared. The child started showing improvement but her ocular movements were restricted due to pseudomembrane formation between globe and lid margin. After 7 days of injury, the pseudomembrane was removed under general anesthesia following which there was healing of conjunctiva. After 4 weeks of treatment corneal edema subsided with complete epithelialization of conjunctiva with visual acuity 6/6.

Chemical injuries due to potassium permanganate are rarely reported. It is a powerful caustic chemical that leads to coagulative necrosis of tissue. It can cause permanent loss of vision rarely.

Immediate management of such injuries is important as it prevents complications and improves the outcome. The mainstay of treatment is immediate and adequate decontamination. The most ideal fluid is ringer lactate as its osmolarity is similar to aqueous humour. In acute stages, topical steroid plays an important role in controlling inflammation. If required, topical antibiotics are given in order to prevent secondary infection. In severe cases, where there are ocular surface deformation and early development of symblepharon, amniotic membrane is used as an adjunctive treatment.

To conclude this case report sensitizes the dermatologists regarding adverse effects of the commonly used topical agent KMnO4 and enhances the awareness of this condition for prompt management.

Source- Kandpal R, Gautam S. Accidental ocular injury by topical dermatological agent: Potassium permanganate (KMnO4). Indian Dermatol Online J 2021;12:752-4.



KMnO4potassium permanganateocular injuryIDOJ
Source : Indian Dermatology Online Journal
Dr Manoj Kumar Nayak
Dr Manoj Kumar Nayak

    MBBS

    Dr Manoj Kumar Nayak has completed his M.B.B.S. from the prestigious institute Bangalore medical college and research institute, Bengaluru. He completed his M.D. Dermatology from AIIMS Rishikesh. He is actively involved in the field of dermatology with special interests in vitiligo, immunobullous disorders, psoriasis and procedural dermatology. His continued interest in academics and recent developments serves as an inspiration to work with medical dialogues.He can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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