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Laboratory science
Release of silicone oil and the off-label use of syringes in ophthalmology
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  • Published on: 24 June 2019
    Potential hazards of silicone oil released by the syringes
    • Gustavo B Melo, Head of the Ophthalmology Residency Program Hospital de Olhos de Sergipe/Federal University of São Paulo
    • Other Contributors:
      • Geoffrey G Emerson, Clinical Assistant Professor

    Dear editor, we received with interest the comments by Wambier et al.1 They provided interestingly new insights in possible adverse effects of silicone oil on the human body. If enlarged lymph nodes and skin nodules assumed as sarcoidosis, and lumps in the abdomen of diabetic patients diagnosed as insulin fat hypertrophy are proved to be secondary to the silicone oil released by the syringes, a remarkable paradigm shift will be achieved. Incidentally, the idea of an inflammatory/immunological association to the presence of silicone oil droplets is in agreement with our yet unproven hypothesis that agitation of the syringe, silicone oil and a susceptible drug may cause non-infectious endophthalmitis after intravitreal injections.2
    However, we have to disagree with two other comments by the authors. Firstly, we employed two complementary techniques of assessing the presence of silicone oil from the syringes: light microscopy and Fourier-transform infrared spectroscopy.3-5 While the former allowed us to state that agitation of the syringe leads to a much higher release of silicone oil droplets with consistent and reproducible data, the latter showed that all models analysed have silicone oil in their interior, except for the oil-free one. Additionally, although it seems more reasonable, the use of a staining method might yield false-positivity, as we saw in our preliminary study.4
    Secondly, we believe that flushing the syringes with saline before drawing the drug...

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    Conflict of Interest:
    None declared.
  • Published on: 3 June 2019
    Here is your injection: would you like with or without silicone oil?
    • Carlos G Wambier, Post-doctoral Associate. Dermatologist. Yale University School of Medicine, Department of Dermatology
    • Other Contributors:
      • Sarah Perillo de Farias Wambier, Associate Professor. Ophthalmologist.
      • Flávio L Beltrame, Associate Professor.

    Dear editor, we have read with great interest the article presented by Melo et al.1 The authors provide good evidence of silicone oil release in injections from lubricated syringes. However, the likelihood of false-negative data may have been high because of lack of a staining method (Sudan III, for example) to differentiate and highlight small droplets, as previously described.2

    Although injectable fluid contamination with syringe silicone oil has been known for decades,3,4 the lack of awareness of all medical specialties about this problem is impressive. The most concerning, still controversial long-term effect of silicone oil exposure is the development of an autoimmune/inflammatory syndrome induced by adjuvants, also known as ASIA syndrome.5

    Given the massive amount of injections given worldwide, silicone oil injected seems safer than one would imagine, however, it is worth remembering that if the physician is unaware of the fact of the silicone oil injection, the diagnosis is omitted as a possible hypothesis. Enlarged lymph nodes or skin nodules with evidence of granulomas are assumed as sarcoidosis, and lumps in the abdomen of diabetic patients are all diagnosed as insulin fat hypertrophy, and if a biopsy is performed, the likely cause of the granuloma would be the injected therapeutic protein or an autoimmune phenomenon. If the physicians are informed that a patient received silicone oil injections the diagnoses change to silicone oil induced granuloma...

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    Conflict of Interest:
    None declared.