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 .
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.