DURING ALMOST 38 years of practice, a few patients have gotten mad at me. Some of you know me; it’s inevitable. The maddest that a patient has ever been with me happened after I prescribed contact lenses and she ended up getting arrested in an incident that cleared out a terminal at the Dallas Fort Worth International Airport.

She thought it would be a neat idea to take some of her prescribed hydrogen peroxide-based lens care solution and place it in a smaller, clear, unmarked bottle. It was easier to get on a plane with the new 3-1-1 liquids rule for carry-on bags. She also had in her purse a bottle of nail polish remover, otherwise known as acetone. What she didn’t realize was that these two chemicals, when combined with hydrochloric acid, form the cyclic trimer, acetone peroxide (Milas and Golubović, 1959).

Triacetone triperoxide (TATP) was used by Richard Reid, the failed “Shoe Bomber.” He failed only because he was acting suspiciously and was prevented from lighting the fuse for this very volatile cocktail (Department of Justice). When successful, it can be a very deadly combination. It is predicted that had he been able to light his fuse, the bomb would have taken the plane down (Federal Bureau of Investigation). The London Bombers in July 2005 killed 53 people and injured more than 700 people with the same types of compounds (Reuters, 2005).

It was previously written in this column that she felt I should have known that this could possibly lead to arrest. I felt that that was unreasonable. However, the more I thought about it, the more I came to believe that she was correct. We should know the implications of everything that we prescribe, whether it is a side effect of a glaucoma medication to the implications of prescribing peroxide to patients.

I think that peroxide care systems are at the top of the soft lens care food chain, and I think the evidence base is with me (Nichols et al, 2019).

Which brings us to why we’re discussing a topic from 10 years ago. A patient recently used the Transportation Security Administration (TSA) necessary liquids policy to declare a bottle of a peroxide-based lens care solution, only to have it taken away from her.

The TSA necessary liquids policy exempts medically necessary liquids when prescribed. Volumes of these liquids in excess of the 3.4 oz limit can be carried on if they are removed from carry-on baggage and declared to the TSA Agent (TSA, 2023a).

Apparently, there is an exception to this exemption. There is a separate policy that states:

TSA allows larger amounts of medically necessary liquids, gels, and aerosols in reasonable quantities for your trip, but you must declare them to security officers at the checkpoint for inspection. Any oversized medically-necessary liquids that alarm during screening, testing positive for certain chemicals, may not be allowed through the screening checkpoint. Some contact lens solutions contain chemicals that typically alarm and may not be permitted through the checkpoint. We recommend placing contact lens solutions over 3.4 ounces in your checked baggage (TSA, 2023b).

As experts, we should be fully versed in this policy. As a caveat to the above policy, there is the following, “The final decision rests with the TSA officer on whether an item is allowed through the checkpoint.” So, it is up to the TSA agent.

Modern bomb screening devices test for nitrogen-based and TATP explosive materials (Jacoby 2018). As such, we should be warning our patients for whom we prescribe peroxide-based care systems to exercise care and follow the policy. CLS

References

1. Milas NA, Golubović A. Studies in Organic Peroxides. XXVI. Organic Peroxides Derived from Acetone and Hydrogen Peroxide. J Am Chem Soc. 1959 Dec 1;81:6461-6462.
2. Department of Justice. British National Indicted for Conspiring with ‘Shoe Bomber’ Richard Reid. 2004 Oct 4. Available at justice.gov/archive/opa/pr/2004/October/04_crm_673.htm . Accessed Nov. 7, 2023.
3. Federal Bureau of Investigation. Richard Reid’s Shoes. Available at fbi.gov/history/artifacts/richard-reids-shoes . 2001 Dec 22. Accessed Nov. 7, 2023.
4. Reuters. London Bombers Used Everyday Materials—U.S. Police. 2005 Aug 4.
5. Nichols J, Chalmer R, Dumbleton K, et al. The Case for Using Hydrogen Peroxide Contact Lens Care Solutions: A Review. Eye Contact Lens. 2019 Mar;45:69-82.
6. TSA. Disabilities and Medical Conditions. Available at tsa.gov/travel/special-procedures . Accessed Nov. 2, 2023.
7. TSA. Contact Lens Solution. Available at tsa.gov/travel/security-screening/whatcanibring/items/contact-lens-solution . Accessed Oct. 15, 2023.
8. Jacoby M. Explosive used in Brussels isn’t hard to detect. Chem Eng News. 2016 Mar 30. Accessed Jan. 18, 2018.