Eyeworld

N EWS 26 | EYEWORLD | DECEMBER 2019 PRESENTATION SPOTLIGHT by Stefanie Petrou Binder, MD EyeWorld Contributing Writer Patient 1 was compliant with medication and follow-up and experienced a slow improve- ment over subsequent visits to the eye clinic. Three weeks into his treatment, he showed 3 mm oval areas of corneal thickening, bilaterally, with underlying endopigment. He was started on vitamin C and prednisolone drops BID. The thickening resolved and the patient was allowed to resume contact lens use 6 weeks following exposure. Pepper spray "Pepper spray exercises, which thousands of police and military personnel participate in each year, are a tradition within the police academy's training routine to increase an officer's empathy and understanding about the potential effects of these weapons on those who are exposed," 1 Dr. Anderson explained. "Some institutions require cadets to engage in mental and phys- ical challenges following exposure, delaying treatment until completion of the tasks. Our patients received questionable direction about how to properly decontaminate after exposure, and this may have worsened their condition. While, like most cadets, they eventually recov- ered, they were clearly at risk for devastating permanent injury based on the severity of their presentation," he said. Studies have shown that most injuries from pepper spray exposure are transient, but others have proven to be long lasting and quite devastating. Documented injuries include ulcers, stromal scars, limbal ischemia, punctate erosions, and neurotrophic keratitis. 2–7 These injuries are due to a combination of mechanical trauma from propellants, chemical exposure to solvents, and nerve-ending damage caused by capsaicin (the active ingredient in OC spray that is extracted from chili peppers). 2,4 "OC sprays are poorly regulated. Studies have shown that these products have inconsis- tent chemical compositions, with some being manufactured in small businesses or private homes. 2,8 Significant differences in OC concen- O leoresin capsicum (OC), also known as pepper spray, is associated with the risk of substantial ocular injury to police officers in training, who experience routine exposure as academy recruits, according to a case series shown as an e-poster at the 2019 ASCRS ASOA Annual Meeting. The e-poster's first author, Tyler Anderson, MD, said he thinks that police recruits should be encour- aged to seek early and appropriate eyecare to avoid serious damage. Case examples Patient 1 was a 29-year-old male contact lens wearer who presented at the Kentucky Universi- ty emergency department suffering from severe eye pain and blurry vision 2 days after pepper spray training exercises at the police academy. Following the exercise, the patient was instructed to wash his eyes with water and baby shampoo. After two days of continued pain and blurry vision despite rinsing and washing his eyes, the patient sought medical care, presenting with large, bilateral epithelial defects and cor- neal edema. His vision was 20/60 OU. Other eye examinations were normal, including IOP, anterior segment, dilated fundus exam, and extraocular movements. Patient 2 was a 25-year-old male with a his- tory of LASIK OU. He presented with a large epithelial defect and corneal edema in his right eye. His vision was 20/50 OD and 20/20 OS. IOP, anterior segment, dilated fundus exam, and extraocular movements were normal. Treatment Both patients were started on erythromycin ointment and seen the next day. On day 2, Pa- tient 2 had improved to 20/40 visual acuity but still had a large epithelial defect. He was told to increase lubrication with both erythromycin ointment and preservative-free tears and asked to return in 2 days. Unfortunately, he was lost to follow-up. Police academy training with pepper spray: Case studies demonstrate startling sequelae About the doctor Tyler Anderson, MD University of Kentucky Lexington, Kentucky References 1. Miletich S. Police Academy 2.0: Less military training, more empathy. The Seattle Times. July 13, 2013. Retrieved from www. seattletimes.com/seattle-news/ police-academy-20-less-mili- tary-training-more-empathy/. 2. Zollman TM, et al. Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva. Ophthal- mology. 2000;107:2186–9. 3. Vesaluoma M, et al. Effects of oleoresin capsicum pepper spray on human corneal morphology and sensitivity. Invest Ophthalmol Vis Sci. 2000;41:2138–47. 4. Kniestedt C, et al. Pepper spray injuries of the anterior segment of the eye. Klin Monbl Augenheilkd. 2005;222:267–270. 5. Shimada M, et al. Corneal ulcer associated with pepper spray exposure during military training. J Emerg Med. 2012;43:e149.

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