|Year : 1982 | Volume
| Issue : 1 | Page : 21-22
Keratoconjunctivitis sicca following instillation of gentian violet
SP Dhir, SK Sharma, VP Munjal, Amod Gupa
Department of Ophthalmology, Postgraduate Institute of Medical Education, and Research, Chandigarh, India
S P Dhir
Department of Ophthalmology, Postgraduate Institute of Medical Education, and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhir S P, Sharma S K, Munjal V P, Gupa A. Keratoconjunctivitis sicca following instillation of gentian violet. Indian J Ophthalmol 1982;30:21-2
Gentian violet, methyl rosaniline chloride is a basic cationic dye and is commonly as an antiseptic in 1%-2% aqueous solution. It is easily available to the general public over the counter. Herein we report an unusual case who developed keratoconjunctivitis sicca following inadvertent instillation of gentian violet solution in both eyes.
S. P., 60 years male was seen on 19.4.1980 with complaints of irritation, pain and diminution of vision for the last 24 hours following instillation of drops in the eyes. On enquiry it was found that a day before he had mild irritation in the eyes for which he consulted a private medical practitioner. The practitioner had inadvertantly instilled 1 % gentian violet into his both eyes. Immediately the patient developed intense burning pain, lacrimation and photophobia. The spilled dye stained his face also. Patient went home and later washed his eyes as he was still having irritation in the eyes. He did not get any relief and consulted us next morning. On examination, his visual acuity was reduced to counting fingers 1/2 metre O.D. and 6/36 O.S. There was moderate lid oedema and blepharospasm. The conjunctivae were congested and chemosed.
Corneas were hazy and oedematosus in both eyes. Biomicroscopic examination revealed punctate epithelial lesions scattered all over the cornea. Right cornea was more adversely affected than the left cornea. These punctate spots stained with fluorescein. Anterior chambers were quiet and fundi were normal. Additionally patient had right amblyopia with exotropia unrelated to the present episode.
He was treated with antibiotic, steroid and cycloplegic drops and eyes were patched. The corneal lesions healed in a period of 4-5 weeks leaving behind fine punctate opacities at the level of bowman's membrane. At the end of 5 weeks, the visual acuity had improved to counting fingers I metre O.D. and 6/9 O.S. By 5th week, the eyes looked dry. Schirmer-1 test was 5 mm O.D. and 3 mm O.D. The marginal tear strip was absent. Tear film break up time was 5 seconds in both eyes. 'The tear secretion has not shown any improvement in a follow up of 4 months.
Experiments were carried out in two rabbits for effect of gentian violet toxicity on conjunctiva. One percent gentian violet drops were instilled in rabbit conjunctival sac thrice in a day. Both the rabbits developed conjunctival congestion and discharge next day. After 3 days of instillation there was some necrosis of the conjunctiva. Conjunctival biopsies obtained from affected rabbits showed variable thinning of epithelial lining with total loss of goblet cells and sub-epithelial capillary congestion with neutrophilic infiltration. [Figure - 2] shows histopathological appearance of normal conjunctiva obtained from a control rabbit.
| Discussion|| |
Gentian violet is still very commonly used in our country as an antiseptic lotion by the general public and medical practitioners alike. Their unawareness of the toxic effects of this dye can result in serious ocular damage. If this dye is instilled accidentally or intentionally (psychiatric disorders) into the eyes, this may lead to keratoconjunctivitis, uveitis and even secondary glaucoma ,,
The ocular damage depends on the concentration of the dye instilled . In our case, 1 solution led to the development of keratoconjunctivitis sicca which has not shown any improvement during the follow up period. The exact mechanism of its injurious effect on the eye is not clear. These cationic dyes are known to enter the cells and stain the nucleic  besides reacting with extracellular mucoproteins.  Apparently, this is responsible for its injurious effect on the conjunctival and corneal epithelium in this patient. Experimental studies in rabbits showed gross destruction of goblet cells and thinning of epithelial lining. It is likely that the dry eye seen in this patient was due to destruction of goblet cells.
First aid measures in the treatment of the eyes contaminated with such dyes consist of copious irrigation with tap water or normal saline. Any left over particles should be removed carefully. Depending upon the severity of kerato-uveitis, combination of steroids and cycloplegics are used. These patients need to be kept under close surveillance for prolonged period for the development of dry eye.
| Summary|| |
Development of keratoconjunctivitis sicca following instillation of gentian violet in both eyes of a patient is reported. In experimental studies on rabbits gentian violet caused gross destruction of goblet cells and thinning of the conjunctival epithelium.
| References|| |
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Vogt. A., Quoted by Grant. W.M., 1962, Toxicology of the eye, 2nd edition, p 206. Charles C. Thomas, Springfield.
[Figure - 1], [Figure - 2]