Elsevier

Burns

Volume 26, Issue 8, December 2000, Pages 689-699
Burns

Eye burns: an emergency and continuing problem

https://doi.org/10.1016/S0305-4179(00)00044-9Get rights and content

Abstract

Adequate treatment of eye burns is an essential task of rescue teams. Clinical and occupational medicine studies have shown that efficient emergency treatment can prevent severe eye damage, but therapy is frequently delayed or inadequate. When initial therapy has been delayed or missed, several treatment strategies, including surgery, are available that may improve the outcome of an injury with poor visual prognosis. Discussed in this review are common accident mechanisms, causative agents and biophysical/pathogenetic aspects of eye burns, together with emergency and long-term treatment strategies including surgical procedures, and factors influencing outcome.

Section snippets

Causative agents and circumstances of accidents

Most accidental eye-burns happen at work. An analysis of cases presenting to our hospital showed 72% occupational vs 28% private accidents. Sixty-three percent of cases involved alkaline agents such as lime or sodium hydroxide, 22% various acids, whilst heat burns from liquid metals or fireworks accounted for about 15%. In almost half (44%) of cases there was a high mechanical impact of the impinging corrosive [1]. These data are in a line with other studies on accidents in ophthalmology [2],

Pathophysiological mechanisms of eye burns

The pathophysiological mechanisms are not as stereotypic as often assumed in the clinical literature. For the adequate assessment of clinical aspects as well as experimental procedures, the circumstances of eye burns should be differentiated with regard to physical parameters including temperature, amount, and impact force, and chemical parameters including pH, concentration, dissociation coefficient (e.g. osmolarity), redox-potential and specific reactivity with the ocular tissues (pK values).

Acute phase

The early clinical presentation of chemical burns to the eye is relatively non-specific and involves corneal oedema and clouding, epithelial loss, and subsequently vascularisation, tissue loss or scarring. The lysis of cellular membranes liberates mediators of chemotaxis and inflammation such as prostaglandins, leukotriens and interleukins leading to an immediate immunological response. The uniform clinical picture does not represent a common chemical or physical mechanism but reflects a

Clinical classification of eye burns

For clinical purposes, a classification of four stages of chemical eye burns has been found to be helpful for the prediction of outcome in the majority of cases (Table 2). In particular, the relative proportion of surviving limbal tissue has been shown to be a major prognostic factor.

Treatment strategies for eye burns

Primary prevention is the most effective measure to tackle chemical eye damage. Once this has failed, fast and simple emergency measures suitable to all possible circumstances should be carried out by a well established and trained emergency team. Therapy of eye burns must reflect both the basic mechanism of the initial event and the subsequent inflammatory response.

Socioeconomic aspects of eye burns

The most common important factor for reducing socioeconomic costs of long-term eye damage is primary prevention, i.e. the reduction of accidents by security precautions wherever possible. If burns occur they have to be managed as effectively as possible to prevent blindness.

Rehabilitation of victims of eye burns depends to a large extend whether one or both eyes have been affected. Patients with bilateral severe eye burns should be informed that it usually takes at least 1–3 years before any

Outlook

First aid courses for everybody should universally stress the need and benefit of adequate irrigation therapy of eye burns. The use of security glasses and shields should be strongly encouraged and the co-distribution of disposable protective equipment with hazardous chemicals should be recommended. Installation of adequate rinsing installations and their maintenance must be regularly controlled. Pharmaceutical research should further improve the composition of irrigation solutions; new rinsing

Acknowledgements

This work has been supported by grants of the Deutsche Forschungsgemeinschaft Re152/27-1, Re152/27-2, Schr387/1, the Faculty of Medicine at the RWTH Aachen START program, and the Aachen Center of Technology — Transfer in Opthalmology AcTO (Germany)1

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