I recently saw a patient who developed significant keratopathy from jalapeo pepper juice. Aside from supportive and prophylactic therapies, could I have done anything else for her?

A: No, says, ophthalmologist Eric D. Donnenfeld, of Rockville Centre, N.Y., and Fairfield, Conn. The toxicity of these peppers is related to a specific toxin, he explains. This burn is not an alkali or acid burn, so using a mild acid or alkali to neutralize the pH is not going to be effective here, he says.

Your stepladder of treatment should consist of: 

Copious irrigation. Flush the eyes with water (or any other neutral solution, such as a saline or contact lens solution) for at least 10 minutes. This helps to reduce the discomfort and rid the eye of any residual chemical, says optome-trist Alan G. Kabat, of Nova Southeastern University College of Optometry in Fort Lauderdale. 

Lubrication. Have the patient use a transiently preserved artificial tear (ie. tears with preservatives that are neutralized by contact to light), such as Refresh Tears (carboxymethylcellulose sodium, Allergan) or TheraTears lubricating eye drops (Advanced Vision Research), every hour until symptoms resolve, says Dr. Donnenfeld.

Dr. Kabat suggests using a moderate-viscosity tear supplement, such as Systane (polyethylene glycol 0.4% and propylene glycol 0.3%, Alcon) or Refresh Liquigel (carboxymethylcellulose sodium, Allergan), every 30 to 60 minutes, at least, during waking hours for the first 24 hours. 

The burn from jalapeo peppers is not an alkali or acid burn, so using a mild acid or alkali to neutralize the pH will not work.

Topical steroid and/or antibiotic. A topical corticosteroid is important for treating severe inflammation. A prophylactic antibiotic may also be necessary because the cornea is compromised. Use a combination corticosteroid-antibiotic, such as TobraDex (tobramycin 0.3% and dexamethasone 0.1%, Alcon) q.i.d. for 24 to 48 hours, or until signs and symptoms show marked improvement, Dr. Kabat says.

Optometrist J. James Thimons, of Fairfield, Conn., says that he prefers using a separate antibiotic and steroid. This allows him to alter the dosing rates to suit the patients needs.

Dr. Donnenfelds advice: Prescribe a mild corticosteroid, such as Lotemax (loteprednol etabonate 0.5% Bausch & Lomb) q.i.d. for one week. If the patient has severe epitheliopathy, prescribe a course of oral doxycycline 100mg twice a day for a week in conjunction with the corticosteroid, he says. 

Topical cycloplegic agents and NSAIDS. To blunt the pain, consider a topical cycloplegic agent, such as 0.25% scopolamine q.d. to b.i.d., and nonsteroidal anti-inflammatory drugs, such as Acular LS (ketorolac tromethamine 0.4%, Allergan), every three to four hours. If, however, the pain is overwhel-ming, and you have the capability to prescribe oral analgesics, do so, Dr. Kabat says. Oral analgesics will not treat the keratopathy but will alleviate the discomfort, he says. Ultram (tramodol 50mg, Ortho-McNeil), Vicodin (hydro-codone bitartrate 5mg and acetominophen 500mg, Abbott) or Tylenol with Codeine (acetamino-phen 300mg and codeine phosphate 30mg, Ortho-McNeil) are all effective in alleviating pain. But, remember that these agents may be habit forming, so do not prescribe more than eight tablets (i.e., q.i.d. for 48 hours).

Look for signs of conditions that can delay ocular surface healing. Blepharitis and meibomianitis are examples of such conditions. Appropriate therapy includes lid hygiene and hot compresses, Dr. Donnenfeld says. Should the patient have infectious blepharitis, prescribe an antibiotic ointment.

Vol. No: 142:6Issue: 6/15/2005