Ocular surface frostbite secondary to ethyl chloride spray

Ethyl chloride (EC) is a fast-acting vapo-coolant spray that provides rapid, transient, local analgesia for minor invasive procedures. Although the application of EC has decreased, it can be used as a cryoanalgesic agent in minor surgical procedures.

Despite the widespread use of EC as a local anesthetic, there are few reported cases of serious adverse side effects.

We report a 67-year old otherwise healthy man who underwent excision of a papilloma on his superior right eyelid by a general practitioner at a primary care center. The lesion was removed by curettage after slight freezing with EC spray. This chemical agent was applied without the adequate eye protection, and eight hours later the patient presented an acute frost injury of ocular surface.

Urgent treatment included copious irrigation of the affected eye, especially the conjunctival fornices, corticosteroid (prednisone) and antibiotic (neomycin) ointment. A week later, the eyelid lesion and keratoconjunctivitis had resolved but evidence of early cicatrization involving the inferior conjucntival fornix and symblepharon formation were present.

To the best of our knowledge, this is the first reported case of an acute burn of the ocular surface following EC spray exposure.

EC should be avoided for short-term local anesthesia in the periocular region to prevent this serious complication.