SIGNS AND SYMPTOMS
In mild to moderate burns, the eye is hyperemic and may display conjunctival chemosis, eyelid edema, first degree burns to the skin, and cells and flare in the anterior chamber. Corneal findings may range from diffuse superficial punctate keratopathy to focal epithelial erosion with mild stromal haze.
When the chemical injury is severe, the eye is not red but appears white
due to ischemia of the conjunctival vessels. Chemosis of the lids and conjunctiva is
evident, and surrounding facial areas may demonstrate second or third degree burns.
Corneal findings include total epithelial erosion with edema and dense stromal hazing, and
sometimes complete opacification.
Alkaline burns occur more frequently and are generally more severe than
acid burns. These solutions destroy the cell structure not only of the epithelium but also
of the stroma and endothelium. While acids create an initial burn and then cease, alkalis
may continue to penetrate the cornea long after the initial trauma. Common sources of
alkalis include ammonia, lye and lime.
Next, test the eye with litmus paper to establish the residual pH. If near neutral (i.e. 6 to 8), the lavage may be discontinued. Check the lids and fornices and remove any particulate matter (more common with drain cleaners, cement, etc.). Debride any necrotic corneal or conjunctival tissue under the biomicroscope, using a cotton-tipped applicator moistened with antibiotic solution; swab the fornices in a similar fashion. Following this, a strong cycloplegic agent (e.g. 0.25% scopolamine) and broad spectrum antibiotic ointment should be instilled.
If significant epithelial erosion has occurred, consider a pressure
patch. In cases of very severe burns, the patient may need to use a topical corticosteroid
judiciously during the first week following trauma (1% prednisolone acetate Q2-4H).
Depending upon the level of pain, a narcotic analgesic may also be necessary. Evaluate
patients daily, and continue medications until resolved. It is also important to monitor
the intraocular pressure; IOP spikes may occur as late complications of chemical burns due
to blockage of the trabecular meshwork by inflammatory debris.
Other reports in this section
Eyelids & Eyelashes | Conjunctiva & Sclera | Cornea
Uvea | Vitreous & Retina | Optic Nerve & Brain | Oculosystemic Disease
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