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Delayed presentation of severe ocular injury from a button battery
G Ratnarajan1, D Calladine, K J Bird
1Department of Ophthalmology, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, UK. g.ratnarajan@gmail.com
Insights
Button battery eye injuries can cause severe electrochemical burns and tissue necrosis. Delayed symptoms may occur, highlighting the importance of prompt diagnosis and treatment for pediatric ocular emergencies.
Area of Science:
- Ophthalmology
- Pediatric Emergency Medicine
- Toxicology
Background:
- Button batteries are common household items, posing a risk of ocular injury in children.
- Ocular button battery ingestion can lead to severe chemical burns due to leakage of alkaline electrolytes.
Observation:
- A 2-year-old girl presented with severe eye pain and discharge due to a conjunctival fornix button battery.
- Initial presentation was delayed, with symptoms manifesting hours after the inciting event.
Findings:
- Ocular examination revealed a metallic foreign body, leading to severe tissue necrosis from an electrochemical burn.
- Despite initial treatment with daily rodding and betamethasone ointment, a mild symblepharon persisted at 3 months.
Implications:
- This case underscores the potential for delayed symptom onset in pediatric button battery ocular injuries.
- Early recognition and management are crucial to prevent long-term visual impairment from these serious eye injuries.
Abstract:
A 2-year-old girl presented to the emergency department at 3:00 h with severe pain in her right eye and a rust coloured, blood stained frothy discharge that had woken her. An examination of her eye revealed a shiny metallic looking foreign body, which was immediately removed by the on-call ophthalmologist. That morning the patient underwent ocular examination under anaesthesia and was found to have severe tissue necrosis resulting from an electrochemical burn. She was treated with daily rodding for 3 days and betamethasone ointment four times a day, which was gradually tapered. At 3 months her only eye pathology was a mild symblepharon between the bulbar and tarsal conjunctiva. This is the first case of delayed symptoms after placement of a button battery into the conjunctival fornix. This case highlights the serious nature of button battery injuries to the eye and the potential to miss the diagnosis owing to a delayed onset of symptoms.
