A five-year-old female, child of a medical assistant working in a tertiary care teaching hospital in the Sultanate of Oman, underwent bilateral routine uneventful cataract extraction and posterior chamber intraocular lens implantation for congenital cataracts. She presented with painful red eyes two weeks post-surgery. The parents had discontinued the postoperative topical steroid (Prednisolone acetate 1%; Predforte® Allergan Inc, Irvine CA) administered four times daily and antibiotic drops (Ofloxacin 0.3% w/v; Exocin® Allergan, Irvine CA) administered four times daily and was instead treated with ‘Wasam’ treatment. At the time of presentation, the vision in the right eye was hand motions and the left eye was 1/50. Both eyes showed conjunctival congestion, corneal edema, retrocorneal membrane formation, posterior synechiae and secondary glaucoma (left eye 25 mmHg, right eye 40 mmHg). B scan ultrasound showed normal posterior segments in both the eyes.\nThere were two circular ulcerated areas on her occiput of about 4 cm diameter.\nThe child was hospitalized for over one month to control the intraocular inflammation, secondary glaucoma and to ensure that the ulcers on the occipital region healed (). Six months later, the secondary glaucoma had resolved, but vision remained unchanged (right eye hand motions and left eye, 1/50). The child had scars of ‘wasam’ in the occipital region.
A 55-year-old Pakistani female with metastatic melanoma underwent branding with a metal rod heated over coal to multiple sites of cutaneous metastases including the right ear, angle of the mandible, middle of the neck and left axillary area (Figure ). The metallic ash was then rubbed onto the resulting wounds. Three days later she presented with fever, tachycardia and hypotension. Physical examination revealed multiple circular full-thickness burns and blisters with central sparing ranging in size from 1 to 6 cm in diameter. The burn margins were erythematous and indurated. Aggressive management of her burns was performed on an inpatient basis. Broad-spectrum oral antibiotics were administered and the wound was treated with topical silver sulfadiazine and clean dressings. Since normal skin acts as a defense mechanism in the body, in our patient, who was already immunocompromised, branding created third degree burns and breached the intact skin seeding the metastatic lesions with infection. Blood and wound cultures grew the same Staphylococcus aureus. She was started on intravenous vancomycin and levofloxacin. Despite aggressive measures, she died in the hospital a week later. Thus, it was either inflicting third degree burn wounds in our immunocompromised patient, or wound contamination due to unsterile techniques that had led to complications in our patient, or a combination of both.