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Objectives To evaluate the etiological cause distribution in chemical eye injuries during COVID-19 pandemic. Methods In this retrospective case series, the medical records of patients, who presented with chemical eye injuries between March 30, 2020, and March 1, 2021, were evaluated and compared with the data covering 10 years before the pandemic. Results Twenty-seven eyes of twenty-three patients (19 adults, 4 children) who presented in pandemic period were included. Alcohol-based hand sanitizer was one of the two most common agents ( n = 6 eyes) in the pandemic era. In the last 10 years before the pandemic, 137 eyes of 102 patients were treated for chemical eye injuries. Injuries due to alcohol-based hand sanitizer increased from 3.1 to 21.1% among all patients, and from 0 to 75% among pediatric patients during the pandemic era compared to the pre-pandemic period. The increase was statistically significant both in all patients ( p = .003) and in the pediatric patient group ( p = .048). Conclusion Due to COVID-19 pandemic, alcohol-based hand sanitizer use became more common. Consequently, the frequency of hand sanitizer related chemical injuries showed a 13-fold increase and the age group affected by such accidents is altered during the pandemic. Three out of four pediatric patients (75%) were injured with alcohol-based hand sanitizers, which draws attention to the fact that improperly placed hand sanitizer stations, being just at the eye level of children, can cause chemical eye injuries in the pediatric population even more.

Objectives: To report the negative fluorescein staining as an early sign of Acanthamoeba keratitis (AK). Methods: Case report and brief review of related literature. Report of Case: A 30-year-old, contact lens wearer, woman presented with mild irritation and pain in the right eye. The best-corrected visual acuity (BCVA) was 20/20 in both eyes. Slit-lamp examination revealed a peripheral corneal infiltration. Empirical antimicrobial therapy was initiated. Within the third day, peripheral corneal opacity regressed but a Y-shaped linear epitheliopathy with a negative fluorescein staining, because of a ridge-like epithelial irregularity, was observed in the central cornea. Clinical findings progressed rapidly. Confocal microscopy revealed hyper-reflective cysts with the typical double-ring sign consistent with AK. Therefore, topical chlorhexidine and propamidine were initiated. Clinical findings regressed subsequently. The final BCVA was 20/20 in both eyes. Conclusion: Acanthamoeba keratitis usually manifest as superficial epitheliopathy and progresses to the stroma. Findings may be obscure or atypical; comprehensive and careful examination may reveal mild findings in the early stages.

Objectives: To report 10 years of pediatric ocular chemical burn experience in a tertiary eye care center in Turkey. Methods: Thirty-three patients aged 18 years and younger who presented with ocular chemical burn between 2011 and 2021 were enrolled. Demographic data and clinical characteristics of patients were reviewed. Limbal stem cell deficiency (LSCD) stage was assessed according to LSCD working group's staging system. The initial and final best-corrected visual acuities were recorded. Results: The mean age was 10.465.5 (0.25-18) years with an F/M ratio of 12/21. Eleven (33.3%) of the patients were injured with acid and 5 (15.1%) with alkaline. The most common causative agent was nail polish remover (n¼7, 21.2%), followed by cologne (n¼5, 15.1%) and hand sanitizer (n¼4, 12.1%). The severity of burn was $grade 4 in 20 patients (60.6%). Chemical injury resulted in LSCD in 18 patients (54.5%). Surgery was performed (LSCD $Stage 2 B) in 13 patients (39.3%); limbal stem cell transplantation (LSCT) (n¼11), staged amniotic membrane transplantation, and symblepharon release (n¼2). Penetrating keratoplasty after LSCT was performed in three of 11 patients. The mean follow-up time was 31.9628.6 months (6-102.33) after the surgery. Conclusions: In pediatric population, accurate diagnosis and management of ocular chemical burns are challenging. Although the severity of burn and consequently LSCD rate seems to be high in children, comparative studies in a larger population are still needed.

To report the management of non-traumatic, non-infectious corneal perforation with limbal allograft transplantation and tectonic keratoplasty in a patient with bilateral vernal keratoconjunctivitis. A 27-year-old male with bilateral vernal keratoconjunctivitis with accompanying limbal stem cell deficiency presented with redness, photophobia and discharge in the right eye. Best corrected visual acuity (BCVA) was 20/640 OD and 20/33 OS. Slit-lamp examination revealed bilateral corneal vascularization due to limbal stem cell deficiency and a 1.5 mm perforation at the paracentral lower temporal cornea of the right eye. Conservative treatment was unsuccessful. Therefore, tectonic keratoplasty with limbal allograft transplantation was performed. Two months later, the patient admitted to the hospital with redness, pain and blurry visual deterioration in the affected eye. Corneal graft was edematous and keratic precipitates on the corneal graft were evident. The patient was diagnosed as corneal allograft rejection and subconjunctival and topical intensive steroid treatment were initiated. One month after treatment, allograft rejection regressed, BCVA was measured as 20/125 OD. He is still stable for 18 months. Keratoplasty combined with limbal allograft transplantation is one of the treatment options in patients with corneal perforation secondary to vernal keratoconjunctivitis accompanying with limbal stem cell deficiency. In these cases, the possibility of allograft rejection should be kept in mind. Patients and their relatives should be informed about the procedure and encourage to admit in any case of redness, pain or visual impairment in order to manage the rejection and provide a prolonged graft survival.