Childhood Onset Anorexia Nervosa and Related Eating Disorders

Two hours after admission the boy's eyes became inflamed and an ophthalmological examination revealed bilateral superficial comeal scarring, and there was also a chemical conjunctivitis making it impossible to open his eyes.

Abstract

poor perfusion.His respiratory rate was 80-90/min with wheeze, inspiratory stridor, central cyanosis, and an oxygen saturation of 85% in air.His heart rate was 160/min and there were profuse oral and nasal secretions requiring repeated suction.The pupils were constricted but the child was too agitated for formal neurological assessment.The cyanosis responded readily to facemask oxygen.Over a period of 24 hours his respiratory rate settled and he remained well saturated in air.However, two hours after admission the boy's eyes became inflamed and an ophthalmological examination revealed bilateral superficial comeal scarring.There was also a chemical conjunctivitis making it impossible for the infant to open his eyes.The child was treated with regular saline (0-9%) irrigation and chloramphenicol prophylaxis, the inflamma- tion settled over the next four days.Fortunately there was no residual scarring.We have been unable to find any reports of nasal instillation of Olbas Oil in infants.Olbas Oil contains oils of peppermint, clove, eucalyptus, menthol, and cajub but it is the latter three that cause the respiratory symptoms.Menthol and eucalyptus are terpenes that if ingested may cause epigastric burning, nausea, vomiting, dizziness, miosis, tachycardia, and a feeling of suffoca- tion.In infants cyanosis, delirium, and convulsions may occur.The respiratory symptoms associated with instillation, although dramatic, resolve eventually and treatment is supportive.Oral poisoning with menthol and eucalyp- tus oils has occurred in the UK2 3 but nasal instillation is more common in Europe where bottles may be confused with normal saline.4However, ocular involvement has been described only after direct application of camphor and eucalyptus.5In young children nasal instillation causes immediate respiratory distress and agitation.This can lead, as in this case, to ocular admin- istration.In patients with severe respiratory symptoms, needing oxygen or ventilation it is important to get an ophthalmic opinion.Untreated the oils can cause local burning and permanent comeal scarring.