Goggles article

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Acute corneal erosion from the use of anti-misting agent in swimming goggles

The number of ways that the human cornea can be injured by physical or chemical agents is extremely variable and sometimes bizarre(1,2). We describe here one such occurrence.

CASE REPORT

A 63 year old man, a keen long-distance swimmer, presented in the casualty department just after completing a 2 hour swim in Lake Bala in Wales. When he had finished the swim and removed his goggles, he found that his left vision was very blurred and he began to notice that it was also painful and gritty. On examination, he was found to have a total epithelial erosion of his left cornea. The right eye was completely normal. The corneal epithelium healed uneventfully over 48 hours although he had occasional grittiness over the next few weeks.

Preceding his swim, he had sprayed the inside of his goggles with "Calotherm", a widely available anti-misting agent (Calotherm International, Raymond House, Beckenham Business Centre, Kent House Lane, Beckenham, BR2 1WA). This is an aqueous solution containing less than 15% Ethoxylated long chain primary alcohols and less than 5% Isopropanol in a pump-action, air-propelled container. As far as he remembers, he followed the manufacturer's instructions by allowing the agent to evaporate to dryness. However, the rims of his goggles were composed of an absorbent sponge material and it is quite likely that he sprayed them as well. He was quite keen to use plenty of spray on the basis that "more of it would work better". The anti-misting agent was recommended to him by a friend and he had only recently begun to use it. He had experienced a similar, less severe episode, also after the use of "Calotherm", a few months previously following an hour long swim off Lanzarote. This was diagnosed as conjunctivitis by a local, emergency doctor and treated with antibiotic drops. He has no previous eye history of eye trauma and there is no corneal dystrophy.

COMMENT

Although the patient is, understandably, not willing to undergo a controlled trial to elucidate the problem further, we are fairly certain that his unusual erosion was caused by alcohol fumes evaporated from his goggles. In a confined space and over a long period of time they could clearly cause epithelial damage as described.

The commonest cause of alcohol damage to the cornea is that due to imperfectly cleaned tonometer heads(3). A similar problem also occurs with hydrogen peroxide(4). Aerosol damage is usually by direct accidental spray damage(5) but can also be malicious(6). In this case the propellant was compressed air by the action of the hand pump and any ocular toxicity must be from the agent alone rather than the propellant, which in other aerosols can be butane or fluorocarbon derivatives. Our patient has now gone back to the old remedy for demisting: spitting on the inside of the goggles before swimming.

We advise, therefore, that swimmers or other people using enclosed goggles for prolonged periods (eg welders) and using "Calotherm" or similar anti-misting agents, should make sure that they are dry in all elements before use. Neither should they use an excessive amount.

References

1. DeRespinis PA; Prohman LP; Microwave popcorn--ocular injury caused by steam (letter) N Engl J Med Oct 25 1990 323 (17) p1212

2. Chang PC; Soong HK; Barnett JM; Corneal penetration by tarantula hairs (letter) Br J Ophthalmol Apr 1991 75 (4) p253-4

3. Soukiasian SH; Asdourian GK; Weiss JS; Kachadoorian HA; A complication from alcohol-swabbed tonometer tips. Am J Ophthalmol Apr 15 1988 105 (4) p424-5

4. Pobrebniak AE; Sugar A; Corneal toxicity from hydrogen peroxide soaked tonometer tips. (Case Report) Arch Ophthalmol Nov 1988 106 (11) p1505

5 . Ben-Nissan D; Savir H; Ocular injury by artificial snow spray Harefauh Dec 2 1990 119 (11) p370

6. Klyve P; Tear gas and eye injuries Tidsskr Nor Laegeforen Jan 29 1992 112 (2) p203-5