24 Purpose: To report the clinical features and management of patients with ocular surface 25 damage during methamphetamine production accidents. 26 Methods: This is a retrospective, non-comparative interventional case series of 5 patients 27 with methamphetamine production related ocular injuries referred to Cincinnati Eye 28 Institute between 1999 and 2014. 29 Results: Four out of five cases were white young men with severe bilateral ocular injury 30 and extremely poor vision. All eyes except

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... one (9 out of 10) were diagnosed with total or 31 near total ocular surface failure. Limbal stem cell transplantation was performed in 8 out 32 of 10 eyes. Keratolimbal allograft was followed by penetrating keratoplasty in 7/10 eyes. 33 Ocular surface stability was achieved in 7 out of 10 eyes after keratolimabl allograft. 34 Post-operative visual acuity was better than 20/200 in 4 out of 10 of eyes. Keratolimbal 35 graft rejection occurred in 3 out of 10; the rate of rejection of penetrating keratoplasty 36 was also three out of ten. 37 Conclusion: Methamphetamine related accidents can lead to severe bilateral ocular 38 injuries. Although stem cell transplantation procedure's success is guarded in most of 39 these patients due to severe conjunctival inflammation and accompanying ocular 40 comorbidities, as well as personality issues, compliant patients can achieve good visual 41 function with ocular surface transplantation and subsequent keratoplasty. 42 43 Key words: methamphetamine, ocular surface, keratolimbal allograft, chemical injury 44 45 3 46