Toxic Reaction

Significant burning and tearing of her eyes and eyelid swelling occurred soon after a 49-year-old woman had a permanent at a hair salon. Her ears also showed signs of a toxic burn. She had never before experienced such a reaction.

Because of their exceptionally loose structure, the subcutaneous tissues of the eyelids quickly become edematous when exposed to any of a variety of noxious stimuli. These stimuli include trauma; insect bites and stings; reactions to food; reactions to oral medications such as systemic angiotensin-converting enzyme inhibitors, especially enalapril, captopril, and lisinopril; and reactions to strong chemicals. In this case, an excessive amount of the hair-curling chemical caused a toxic reaction.

This type of angioedematous swelling must be differentiated from chronic eyelid edema that results from Grave's ophthalmopathy, cardiovascular disease, renal disease, or lymphedema after the lymph drainage system from the eyelid is interrupted. Clues to a diagnosis of a toxic reaction include the rapid, sudden onset of angioedema; no history of systemic disease and associated ocular findings, such as exophthalmos seen in Grave's disease; and recent exposure to a possible toxic stimulus.

Cool compresses and oral antihistamines were prescribed to treat the eyelid swelling. The mild conjunctival reaction that caused the ocular burning and tearing was eased by lubricating with nonpreserved artificial tears. Bacitracin antibiotic ointment was recommended to prevent secondary infection of the patient's ears.

The patient also needs to look for another hairdresser!