SILVER-NITRATE BURN FOLLOWING CREDE PROPHYLAXIS

Following Crede's prophylaxis with silver-nitrate, the cornea of a newborn presented greyish-brown, lime-like plaques On the nasal part of the right eye. A paracentral ulcerating stromal opacification undermined these apposition, when the patient was admitted to the eye-clinic at Aachen. In the material taken in a lamellar keratectomy scanning electron microscopial examination was able to prove the existence of granules, previously described in light-microscopy. These granules measured 100 to 300 nm in diameter and were placed up to 110-mu-m deep into the corneal stroma of the specimen. An earlier chemical analysis of necrotic material showed no silver specific reaction. By means of EDX-Analysis these granules could be identified as silver-containing. This was once reassured by a newly developed modification of van-Kossa's-staining-method. The fact that the granular deposits contained mainly silver proves that the onset of a sodium-chloride-irrigation did not promote an intended therapeutic silver-chloride-precipitation and therefore had no effects on the silver-nitrate's penetration abilities. Injuries by silvernitrate-solutions used for Crede's prophylaxis are seldom but still reported. The mechanism of injury in this case of a child, born by sectio remains unknown. Neither the use of an unusual silvernitrate solution, that was taken from a disposable ampoule (Mova-Nitrat(R)) was reported, nor any corneal injury during sectio mentioned. Nevertheless the method of EDX-Analysis and SEM proved the diagnosis of corneal silver deposits, so that the origin of the granular opacification of the cornea could be determined. Colour, size and location of silver deposits are reviewed and a mechanism for penetration of silver in the cornea is discussed. Finally several important precautions for a non-traumatic Crede's prophxylaxis are given. The use of silvernitrate in case of possibly existing corneal wounds must be avoided.