Urgent Care Management of Nail Glue (Cyanoacrylate) in the Eye
Begin immediate copious irrigation with sterile saline to remove unpolymerized adhesive, avoid any mechanical manipulation of bonded glue, apply preservative-free lubricants every 2 hours, and arrange urgent ophthalmology consultation for fluorescein examination and ongoing management. 1
Immediate Actions at Presentation
Do NOT Do These Things
- Never attempt mechanical removal or manipulation of adhesive that has already bonded to ocular tissues – this causes corneal epithelial defects and potentially full-thickness corneal damage 1
- Do not blindly sweep the fornices with cotton swabs or glass rods – this creates additional mechanical trauma to already compromised tissue 1
- Do not initiate topical corticosteroids without ophthalmology supervision – steroids mask signs of infectious keratitis and are dangerous when corneal epithelial defects are present 1
What You Should Do First
- Irrigate copiously with sterile saline immediately to flush out any unpolymerized adhesive before it bonds to ocular tissues 1
- Apply preservative-free lubricants (hyaluronate or carmellose drops) every 2 hours to maintain corneal hydration and comfort 1
- Arrange urgent same-day ophthalmology consultation for comprehensive slit-lamp examination with fluorescein staining to assess corneal and conjunctival epithelial integrity 1
Ophthalmology-Directed Management
Once the ophthalmologist examines the eye and identifies corneal epithelial defects:
Infection Prophylaxis
- Initiate prophylactic broad-spectrum topical fluoroquinolone (moxifloxacin or levofloxacin) four times daily if any corneal epithelial defects are present on fluorescein staining 1
Corneal Protection
- Consider bandage contact lens placement (thin, high water content, high oxygen permeability) to protect the cornea and provide comfort if epithelial defects are present 1
- Warn patients that bandage contact lenses increase microbial keratitis risk 10- to 15-fold and they must immediately contact ophthalmology if symptoms worsen 1
Follow-Up Protocol
- Schedule daily ophthalmologic follow-up to monitor for infectious keratitis (increasing pain, redness, or photophobia) 1
Long-Term Management Strategy
Allow spontaneous separation of bonded adhesive over time (typically 6 weeks or longer) rather than attempting mechanical removal – this is the cornerstone of management once glue has polymerized 1
- Maintain frequent preservative-free artificial tears if adhesive has bonded to ocular tissues 1
- Cyanoacrylate exerts minimal thermal, chemical, or toxic effects on the ocular surface and has a very favorable prognosis with conservative management 2
Why This Approach Works
The key distinction is between unpolymerized versus polymerized adhesive:
- Unpolymerized glue can be flushed away with irrigation 1
- Once polymerized (bonded), mechanical removal causes more harm than waiting for spontaneous separation 1, 2
- Visual function returns to normal in all patients managed conservatively, with no persistent tissue damage 2
Common Pitfalls in Urgent Care
- Attempting to peel or scrape off bonded glue – this is the most common error and causes severe corneal abrasions 1, 3
- Delaying ophthalmology referral – same-day consultation is mandatory to assess extent of injury 1
- Failing to provide adequate lubrication – the eye needs every-2-hour drops to prevent desiccation during the healing phase 1