Registration Dossier

Toxicological information

Direct observations: clinical cases, poisoning incidents and other

Administrative data

Endpoint:
direct observations: clinical cases, poisoning incidents and other
Type of information:
other: case report
Adequacy of study:
supporting study
Reliability:
2 (reliable with restrictions)
Rationale for reliability incl. deficiencies:
other: Well documented

Data source

Reference
Reference Type:
publication
Title:
Chemical Injury to the Eye from Trichloroacetic Acid
Author:
Fung JF, Sengelmann RD and Kenneally CZ
Year:
2002
Bibliographic source:
Dermatol Surg 28: 609-610

Materials and methods

Study type:
clinical case study
Endpoint addressed:
eye irritation
Principles of method if other than guideline:
Case report.

Test material

Reference
Name:
Unnamed
Type:
Constituent
Details on test material:
- Name of test material (as cited in study report): trichloroacetic acid (TCA)

Method

Type of population:
general
Subjects:
The patient is a 47-year-old woman who was undergoing 35% TCA peel of the face for dyschromia and a desire for skin rejuvenation.
Details on exposure:
The face was first cleansed with a gentle cleanser, alcohol, and acetone. Petrolatum was applied to periocular, perinasal, and perioral mucosal surfaces to protect against seepage into these areas. The patient was supine and urged to keep her eyes tightly closed throughout. The 35% TCA was applied with cotton to the entire face for 2 minutes until erythema and frosting were evident. Ice water was then used to soothe and comfort the patient’s face.
Medical treatment:
Shortly thereafter she began to complain of irritation and burning of the left eye, which was noted to have excessive tearing and marked conjunctival injection. Her eye was immediately flushed with 100 cc of an isotonic, buffered, sterile eye irrigating solution. Ophthalmology was called, and the patient was advised to use double antibiotic ophthalmic ointment, ibuprofen 400 mg by mouth three times a day, and cool compresses until she could be seen the following morning. Ophthalmologic evaluation ultimately revealed conjunctival infection and mild inferior superficial punctate keratitis involving 25% of the cornea. With continued supportive care there was rapid improvement and complete corneal healing within 72 hours. There were no lasting effects.

Results and discussion

Applicant's summary and conclusion

Conclusions:
The patient is a 47-year-old woman who was undergoing 35% TCA peel of the face for dyschromia and a desire for skin rejuvenation. The patient deveoped marked conjunctivitis of the affected eye and abrasions involving 25% of the cornea. Trichloroacetic acid must be applied carefully around the eyes to avoid ocular complications, which albeit rare, can be quite grave if not addressed in a timely manner.
Executive summary:

The patient is a 47-year-old woman who was undergoing 35% TCA peel of the face for dyschromia and a desire for skin rejuvenation. The face was first cleansed with a gentle cleanser, alcohol, and acetone. Petrolatum was applied to periocular, perinasal, and perioral mucosal surfaces to protect against seepage into these areas. The patient was supine and urged to keep her eyes tightly closed throughout. The 35% TCA was applied with cotton to the entire face for 2 minutes until erythema and frosting were evident. Ice water was then used to soothe and comfort the patient’s face. Shortly thereafter she began to complain of irritation and burning of the left eye, which was noted to have excessive tearing and marked conjunctival injection. Her eye was immediately flushed with 100 cc of an isotonic, buffered, sterile eye irrigating solution. Ophthalmology was called, and the patient was advised to use double antibiotic ophthalmic ointment, ibuprofen 400 mg by mouth three times a day, and cool compresses until she could be seen the following morning. Ophthalmologic evaluation ultimately revealed conjunctival infection and mild inferior superficial punctate keratitis involving 25% of the cornea. With continued supportive care there was rapid improvement and complete corneal healing within 72 hours. There were no lasting effects.