A 55-year-old man presented to the emergency room with chief complaints of decreased vision, severe pain, tearing, and photophobia of his left eye after administering a drop of Kermes topical eye drops, which he obtained from a homeopathic/folk medicine man. Apart from hypertension, the patient’s medical history was unremarkable.\nOphthalmic examination revealed best corrected visual acuity of 20/30 in the right eye (OD) and 20/200 in the left eye (OS). Examination of the OD was unremarkable except for mild cataract. Examination of OS revealed swelling and black pigmentation over the upper eyelid. There was conjunctival chemosis along with well-demarcated black elevated areas inferonasally. Evidence of early cicatrization involving the fornix of the conjunctiva and symblepharon formation were present. Some particulate material from the lower fornix was removed and submitted for chemical analysis. Administration of topical fluorescein hydrochloride revealed a large epithelial defect involving the whole cornea []. There was no evidence of perilimbal ischemia. Intraocular pressure was normal in both eyes.\nThe left eye was immediately irrigated with normal saline for 30 min. The patient was instructed to frequently lubricate the left eye with preservative-free artificial tears in addition to the administration of topical Ofloxacin 0.3% drops 4 times a day for 1 week and topical prednisolone acetate 1% 4 times a day for the first week then it was tapered. In addition, topical cyclopentolate 1% drops 2 times a day were prescribed for the first 2 weeks. Over the following several days, the patient’s best corrected visual acuity improved to 20/60. Eyelid swelling along with skin discoloration completely resolved. The corneal epithelial defect healed completely without scarring \n[].\nGas chromatography/mass spectrometry of the submitted sample revealed the main ingredient to be kermesic acid (C18H12O9) consistent with Kermes. In addition to kermesic acid, there were elements of barium, iron, manganese, potassium, and copper. Six months after presentation, symblepharon was still noted, however, the best corrected visual acuity OS was 20/25 without corneal scar.
A 56-year-old female was referred to King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, with central corneal thinning in her left eye and a scar. She reported a painless decrease in vision following the self-application of alum substances to her left eye for eye redness and discomfort. There was no history of previous trauma, surgery, or any ophthalmic disorder. There was no history of any systemic illness or use of any systemic or topical medications. Ophthalmic examination indicated the best-corrected visual acuity of 20/20 in the right eye (OD) and counting fingers at 1 m in the left eye (OS). Intraocular pressure measured with applanation tonometry was within the normal range bilaterally. Examination of the right eye was unremarkable except for a mild cataract. Slit-lamp examination of the left eye indicated a quiet conjunctiva and central corneal scar with no corneal epithelial defect; there was corneal thinning without descemetocele, nuclear sclerosis, and a hazy view of the fundus []. B-scan ultrasonography OS indicated no pathology at the posterior pole. The alum substance was analyzed using scanning electron microscope (SEM) and revealed the elements shown in .