Management of Dermabond (Cyanoacrylate) Exposure to the Eye
Do not attempt to forcibly remove cyanoacrylate adhesive from the eye, as this can cause severe mechanical trauma to the cornea and conjunctiva. 1
Immediate Actions That Are NOT Appropriate
The following interventions should be avoided when Dermabond drips into the eye:
Never rub or mechanically manipulate the adhesive, as this will cause corneal epithelial defects and potentially full-thickness corneal damage 2
Do not use organic solvents or acetone to dissolve the adhesive, as these are highly toxic to ocular tissues 3
Avoid blind sweeping of the fornices with cotton swabs or glass rods, which can cause additional mechanical damage to already compromised tissue 2
Do not apply topical corticosteroids as first-line therapy without ruling out corneal infection, as steroids can mask signs of infectious keratitis and should be used with extreme caution in the presence of corneal epithelial defects 2
Appropriate Initial Management
When cyanoacrylate adhesive enters the eye, the correct approach involves:
Immediate copious irrigation with sterile saline to remove any unpolymerized adhesive before it bonds to ocular tissues 2
Urgent ophthalmology consultation for comprehensive examination including fluorescein staining to assess corneal and conjunctival epithelial integrity 2
Application of preservative-free lubricants (hyaluronate or carmellose drops) every 2 hours to maintain corneal hydration and comfort 2
Subsequent Management Based on Ophthalmologic Assessment
If Corneal Epithelial Defects Are Present:
Apply a bandage contact lens (thin, high water content, high oxygen permeability) to protect the cornea and provide comfort 2, 4
Initiate prophylactic broad-spectrum topical antibiotics (fluoroquinolone such as moxifloxacin or levofloxacin four times daily) to prevent secondary infection 2, 4
Daily ophthalmologic follow-up is mandatory to monitor for infectious keratitis, which manifests as increasing pain, redness, or photophobia 2
If Adhesive Has Bonded to Ocular Tissues:
Allow spontaneous separation over time (typically 6 weeks or longer) rather than attempting mechanical removal 1
Maintain ocular surface lubrication with frequent preservative-free artificial tears 2
Monitor for complications including symblepharon formation (conjunctival adhesions) requiring daily gentle breakdown with saline irrigation by an ophthalmologist 2
Critical Safety Considerations
Patients wearing bandage contact lenses must be explicitly warned that they have a 10- to 15-fold increased risk of microbial keratitis and must immediately contact their ophthalmologist if symptoms worsen 2, 4
The key principle is that cyanoacrylate adhesive, while useful for corneal perforations when intentionally applied to prepared tissue, becomes a foreign body requiring conservative management when accidentally introduced to the eye 1, 3. Aggressive intervention causes more harm than allowing natural separation while protecting the ocular surface.