What is the proper procedure for removing superglue (cyanoacrylate) from the eye?

Management of Superglue (Cyanoacrylate) in the Eye

Do not attempt mechanical removal or blind sweeping of the eye—instead, irrigate immediately with copious sterile saline, apply preservative-free lubricants every 2 hours, and obtain urgent ophthalmology consultation, as the adhesive will spontaneously separate over 6 weeks without aggressive manipulation. 1

Immediate Actions (First Minutes)

• Irrigate copiously with sterile saline to remove any unpolymerized adhesive before it bonds to ocular tissues 1
• Do NOT mechanically manipulate or attempt to peel off the adhesive, as this causes corneal epithelial defects and potentially full-thickness corneal damage 1
• Avoid blind sweeping with cotton swabs or glass rods, which causes additional mechanical damage to already compromised tissue 2, 1
• If eyelids are stuck together, gently separate them by pulling the lid margins with fingers or by trimming the glue-matted eyelashes 3, 4

Essential Ophthalmology Evaluation

• Obtain urgent ophthalmology consultation for comprehensive examination including fluorescein staining to assess corneal and conjunctival epithelial integrity 1
• The examination should specifically look for corneal abrasions (present in 33.8% of cases), foreign body sensation (41.8% of cases), and conjunctivitis (11.0% of cases) 5
• Daily ophthalmologic follow-up is necessary to monitor for infectious keratitis, which manifests as increasing pain, redness, or photophobia 1

Medical Management

Lubrication Protocol

• Apply preservative-free lubricants (hyaluronate or carmellose drops) every 2 hours to maintain corneal hydration and comfort 2, 1
• Continue frequent lubrication if adhesive has bonded to ocular tissues 1

Antibiotic Prophylaxis

• Initiate prophylactic broad-spectrum topical antibiotics (fluoroquinolone such as moxifloxacin or levofloxacin four times daily) if corneal epithelial defects are present 2, 1
• This prevents secondary infection in compromised corneal tissue 1

Bandage Contact Lens

• Apply a bandage contact lens (thin, high water content, high oxygen permeability) to protect the cornea and provide comfort if corneal epithelial defects are present 1
• Critical warning: Patients wearing bandage contact lenses have a 10- to 15-fold increased risk of microbial keratitis and must immediately contact their ophthalmologist if symptoms worsen 1

Definitive Management Strategy

• Allow spontaneous separation over time (typically 6 weeks or longer) rather than attempting mechanical removal if the adhesive has bonded to ocular tissues 1, 6
• Vigorous manipulations are more harmful than useful, and spontaneous rejection of the glue should be awaited 6
• The clinical course after superglue injuries is usually benign despite the dramatic acute appearance 6
• Remaining glue is typically spontaneously rejected within hours to days 6

What NOT to Do

• 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, 1
• Do NOT attempt aggressive mechanical removal of bonded adhesive, as this causes more damage than the adhesive itself 1, 6
• Do NOT use cotton swabs or glass rods to sweep the fornices 2, 1

Expected Clinical Course

• Subtotal corneal erosions typically heal within 4 days with visual function returning almost to normal 6
• The adhesive may remain in place for 6 weeks or longer if properly managed conservatively 1
• Most cases resolve without permanent visual impairment when managed appropriately 6, 3

Prevention Context

This injury commonly occurs because superglue tubes resemble eye ointment tubes, with 20.8% of cases involving patients mistaking nail glue for eye drops 4, 5