In this episode, I’ll discuss what happens if you accidentally get rocuronium in your eye.
While the Material Safety Data Sheet for rocuronium states “…inadvertent eye contact with this product may produce irritation with redness and discomfort,” there were no reports of accidental ocular exposure to rocuronium until recently. A case report of such exposure was recently published as a letter to the editor in Annals of Emergency Medicine.
A 31-year-old female was at work drawing up 100 mg of rocuronium bromide in an emergency department setting. The lid on one vial of rocuronium opened and she was exposed to rocuronium in her left eye. While the most that could have been exposed to the eye was 50 mg (the contents of the vial) the actual exposure was likely considerably less. She used an eyewash station to irrigate her eye for 5 minutes.
Her only symptoms were “heaviness” of her left eyelid and mild blurry vision. She had no reports of respiratory symptoms, extremity weakness, headache, double vision, eye pain, or sensory deficits. On physical exam she did have some slight abnormalities in eyelid strength and forehead appearance on the side that was exposed to rocuronium. All other components of the physical exam were normal including pupil size and reactivity.
The regional Poison Control Center was contacted however they had no reports of ocular exposure to rocuronium or exposure via any other mucous membrane.
Out of an abundance of caution it was decided to monitor the patient in the ED for 2 hours to exclude the possibility of respiratory weakness or depression.
All symptoms resolved after 2 hours and the patient was able to return back to work.
The authors of the letter recommend this 2 hour observation period for any accidental mucosal exposure to rocuronium. The only step detailed in the MSDS that was not mentioned in the case report is that if contact lenses are presented, they should be removed with additional rinsing of the eyes with water after the lens are removed.
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