Frozen corneas in the desert: a case report

Abstract

This is a rare case of freezing of the corneas in extremely cold conditions. A large proportion of the worlds’ population inhabits areas where frequent exposure to subzero temperatures is common. Early recognition, appropriate referral and treatment of frozen corneas may help to minimize any potential complications that can develop later on, as well as reduce pain and suffering for the patient. A 39-year-old white man presented with a 48-h history of severe bilateral ocular pain, redness and photophobia. He denied any recollection of infection, trauma or foreign body entering the eyes, and his symptoms started after boarding a long-haul flight from Canada to the United Arab Emirates. During his stay in Canada the patient had frequently participated in winter sports, and right up until departure, had been exposed to an extremely cold outdoor environment. On examination he was found to have bilateral diffuse staining of the corneal epithelium. No other cause of such corneal injury could be found from the history or clinical examination, and his features were thought to be due to corneal freezing with subsequent thawing of tissue. He was started on intensive ocular lubricants, topical antibiotics, together with a mydriatic agent and topical non-steroidal anti-inflammatories. Subsequently his symptoms and visual acuity rapidly improved. After 1 week his unaided visual acuity was back to 6/6 and he was subsequently discharged. Freezing of the corneas is uncommon and occurs in individuals who have kept their eyes open in high-wind-chill and freezing temperatures without protective goggles. Soldiers, pilots, skiers, bicyclists, ice skaters, and snowmobilers and mountaineers are at particular risk. Treatment focuses on controlling inflammation and preventing secondary infection, and includes cycloplegia, eyelid closure with a dressing, topical lubricants, antibiotics and steroids. The prognosis is favourable provided there has been no damage deep to Bowman's layer. Severe keratitis may require lamellar and penetrating keratoplasty. Corneal freezing injuries should be kept in mind in emergency rooms particularly in areas where outside temperatures are extremely cold, and where members of the public are routinely exposed to high wind chill such as participants in winter sports and also military personnel. Educating these groups of people about potential injuries to cold is important for prevention of lasting permanent damage to the ocular structures and other tissues in the body.