Chemical Eye Injury

ByDr. Safaa Refaat

FRCSG Ophth, MSc , MBBS.

ن� حم� الر� الله� ب�سم�

يم� ح� الر� “ العالمين” رب� لله� الحمد� وقيل�

In Chemical Eye InjuryWASH

Is Every Thing!

Chemical Eye InjuryChemical injuries are among the most destructive of all traumatic insults suffered by the eye .

They may occur in domestic, industrial, and military settings.

Alkalis (OH) cause Liquefactive necrosis and so penetrate further than acidsAcids (H) cause Coagulative necrosis and so impede their own progress.But Note That: very acidic solutions may behave like Alkalis.

PH 7.4

CornealInvolveme

nt

Durationof Contact

Prognostic factors

*PH *Duration of Contact

*Extent of Corneal Involvement*Limbal Involvement: Re-

epithelialization relies on migration of the limbal stem cells.

*Associated nonchemical injury: blunt trauma, thermal injury.

Prognostic factors

Clinical features -Conjunctival injection or

blanching, chemosis, hemorrhage, epithelial defects

-Corneal epitheliopathy, punctate to complete loss, corneal edema; perilimbal ischemia, anterior chamber reaction

-Intra Ocular Pressure raise -Necrotic Retinopathy.

-Eye Lids Burn and associated Facial Burn.

Alkali Burn

Acid Burn

Complications• Conjunctival

scarring, symblepharon, & keratoconjunctivitis sicca (Dry Eye)

•Significant limbal ischemia: conjunctivalization, vascularization, Corneal opacification

ComplicationsCorneal Melting & Perforation

•Full-thickness burns: hypotony, iris, ciliary, and lenticular damage; may progress to phthisis bulbi; very poor prognosi

•Periorbital burns :first-, second-, or third-degree chemical burns of periorbital tissues

Complications

Table 1: Chemical injury grading (Roper–Hall classification)Grade Corneal

appearance Limbal ischemia

Prognosis

Grade I Clear cornea None Good

Grade II Hazy cornea: iris details visible

<1/3 Good

Grade III Opaque cornea: iris details obscured

1/3 to 1/2 Guarded

Grade IV Opaque cornea: iris details obscured

>1/2 Poor

Table 2: Strong Alkalis in common use

Common alkalisSubstance

Chemical PH

Oven cleaning fluid

Sodium hydroxide

14

Drain cleaning fluid

Sodium (or potassium) hydroxide

14

Plaster Calcium hydroxide

14

Fertilizers (some)

Ammonium hydroxide

13

Common acidsSubstance

Chemical PH

Battery fl uid

Sulfuric acid 1

Lavatory cleaning fluid

Sulfuric acid 1

Bleach Sodium hypochlorite

1

Pool cleaning fluid

Sodium (or calcium) hypochlorite

1

Table 2: Strong Acids in common use

Chemical Eye Burn: Managment

Early•Minutes counts against your patient!

Don’t wait for the Ophthalmologist to Reach

Effective•To achieve Neutral pH,

Avarage from 2 to 8 liter is needed

IrrigationEffectiveEarly

Chemical Eye Burn: First Aid At Home

Wash under running water for 20 to 45 minutes

Chemical Eye Burn: First Aid At work Bath Station at our

lab

Chemical Eye Burn: Immediate treatmentNeutralization of pH by irrigation

*Even before a full history or detailed examination is conducted

*Copious Irrigation in cycles of 2 litre then rest 10 min. check pH & Repeat until neutral or near-neutral pH is confirmed by

pH/ litmus paper.*Evert the lids to remove retained

particulate matter in fornices (e.g., lime, cement).

IrrigationEffectiveEarly

IrrigationEffectiveEarly

1

9876

5

3

4

2

Record & Document:

-Time started & Time Ended Irrigation -Amount & Type of fluid used

-pH records and times they measured- Visual Acuity- Date & Signature of care giver

-Send to ophthalmic Department !

Chemical Eye Burn -Further treatment:

•Topical antibiotics prophylaxis. •Topical cycloplegia for comfort/AC activity

•Topical lubricants per hour. •Oral analgesia.

Topical medication should be preservative-free when possible.

• Topical steroids• Topical & Oral ascorbic acid: essential for

collagen formation and is an effective scavenger of damaging free radicals. (Not in acid burn)

• Systemic Tetracycline: (proteinease inhibitor & anti-inflamatory properties)

. Antiglaucoma medications: if raised IOP:Give acetazolamide ± topical B-blocker

Chemical Eye Burn -Further treatment for severe injury:

Long-term—complicated casesPoor corneal healing:

-conjunctival graft,-limbal stem cell graft,-amniotic membrane graft .

Corneal opacifi cation:-Penetrating keratoplasty: wait 6 months, Rejection Risk.

Keratoprosthesis : for severely damaged eyes.

In Chemical Eye InjuryEarly & Effective

Irrigation Is Crucial In Saving Vision!

THANK YOU