CHEMICAL INJURIES

Dr. Mustafa Abdul Hameed Ismail

Causes

Range from trivial to potentially blinding.

Accidental or assault.
2/3rd accidents at work place.
Alkali burns are twice as common as acid
burns.

Severity of chemical injury is related to

Properties of chemical
Area of affected ocular surface
Duration of exposure
Related effects like thermal injury etc.

Alkalis tend to penetrate more deep than

acids?

Pathophysiology
Damage by severe chemical injury occur in
following order
Necrosis of conjunctiva and corneal epithelium with
disruption and occlusion of the limbal
vasculature.
Loss of limbal stem cells result in
conjunctivalization of corneal surface and
persisting epithelial defects.
Corneal ulceration and perforation.

Ocular surface wetting disorders, symblephron

formation and cicatricial entropion.
Corneal stromal opacities
AC penetration-iritis and lens damage.
Ciliary epithelial damage- impaired secretion of
ascorbats required for corneal repair.
Hypotony and phthisis bulbi.

Management

A chemical burn is the only eye

injury that requires emergency
treatment without first taking a
history and performing a careful
examination.

Copious irrigation.

Normal saline or Ringer lactate for 15-30

min or neutral.

Double aversion of upper eye lid for

removal of retained particulate matter
Debridement of necrotic areas
Admission for severe injuries.

Grading of severity
To plan appropriate treatment and indicate likely prognosis

Grading on the basis of corneal clarity and severity of limbal

ischemia.

Grade 1 Clear cornea ( epithelial damage) no limbal ischemia.excellent prognosis

Grade 2 hazy cornea with visible iris details and < 1/3 rd limbal
ischemia-good prognosis
Grade 3 total loss of corneal epithelium, stromal haze
obscuring iris and 1/3 to limbal ischemia.- guarded prognosis.
Grade 4 opaque cornea, > limbal ischemia- very poor
prognosis.

Medical treatment
Main aims of treatment
Reduce inflammation
Promote epithelial regeneration
Prevent corneal ulceration.
Grade 1and 2
Toical antibiotics, topical steroids and
cycloplegics.

Steroids

Used initially to reduce inflammation

Must be tapered off after 7-10 days.
May be replaced by NSAIDs.

Cycloplegics
Prophylactic topical antibiotics

Ascorbic aid

Citric acid

Powerful inhibitor of neutrophil activity and reduce

inflammation

Tetra-cyclines

Improves wound healing

Promotes synthesis of mature collaegen

Effective collagenase inhibitors, inhibit neutrophil

activity and reduce ulcers

Symblepharon formation to be prevented.

Monitor IOP.

Surgery

EARLY

To promote revascularization of limbus

Restore limbal cell population
Re-establish the fornices.

Advancement of Tenons capsule

Limbal stem cell transplantation
Amniotic membrane grafting

LATE
Division of conj. bands and treating
symblepharon
Correction of eye lid deformity
Conjunctival or mucous membrane
grafting.
Keratoplasty
Kerato-prosthesis.