Use of Non-medical-grade Ethyl Cyanoacrylate for Temporary Skin Closure in a Bleeding Upper Eyelid Arteriovenous Malformation: A Case Report.
Pe Yan Mary Rose MR, Alhasan Yasser E YE, Lumba Gerald Jan M GJM
Cutaneous arteriovenous malformations (AVMs) of the eyelid and orbit are rare vascular anomalies that can present with recurrent or spontaneous bleeding, particularly when the overlying skin is thinned. While definitive management involves embolization and surgical excision, achieving rapid hemostasis can be challenging in resource-limited or outpatient settings. This case report aims to describe the emergency use of non-medical-grade ethyl cyanoacrylate (CA) to achieve temporary hemostasis in an upper eyelid AVM when standard medical materials were unavailable, and to discuss its safety, limitations, and ethical considerations in resource-constrained circumstances. A 23-year-old male with a known right upper eyelid and orbital AVM, scheduled for preoperative embolization, presented with a one-week history of recurrent, profuse bleeding from a superficial skin defect overlying the lesion. Each prior bleeding episode had been controlled with approximately five minutes of firm pressure. On the day of emergency consultation, however, the patient experienced continuous bleeding that persisted despite several hours of pressure dressing. As an immediate hemostatic measure, a thin layer of non-medical-grade ethyl CA was applied to the bleeding surface, resulting in prompt cessation of hemorrhage with only minimal oozing afterward. The wound subsequently healed without secondary infection, tissue necrosis, or other complications. This case demonstrates that non-medical-grade ethyl CA may serve as a temporary hemostatic adjunct for superficial bleeding in select, resource-constrained situations involving eyelid AVMs. While potentially useful in emergencies, its application must remain cautious, limited, and followed by definitive nidus-directed management. Further reports are needed to clarify safety and standardized guidance for its emergency use.