Chemical injuries

Introduction

What? Area

Duration of

exposureVolume

Introduction

• Alkali is more common than acid• Alkalis penetrate more deeply than acids• Common alkalis = ammonia, sodium

hydroxide and lime• Common acids = sulphuric, sulphurous,

hydrofluoric, acetic, chromic and hydrochloric

Alkali burns

Acid burns

Damage Structure Damage Lids Cicatricial entropionConjunctiva Necrosis, symblepharon

fromationCornea Necrosis, stromal

opacification, vascularization, perforation

Anterior chamber Iiris and lens damage

Ciliary body epithelial damage= Impairs secretion of ascorbate

Management

• Emergency management• Medical treatment• Surgery

Emergency management

• Copious irrigation • Double eversion of the upper eyelid • Debridement of necrotic areas of corneal

epithelium• Admission

Copious irrigation

Double eversion

Debridement

• Debridement of necrotic areas of corneal epithelium promote re-epitheliazation and remove associated chemical residue

Admission

• Required for severe injuries in order to ensure adequate eye drop instillation in the early stages

Grading of severity

Management AIM• Reduce inflammation• Promote epithelial regeneration• Prevent corneal ulceration

Cont.• Cycloplegic• Topical antibiotics• Topical steroids• Oral analgesics• Tetracycline• Control IOP• Ascorbic acid• Citric acid

Surgery AIM

• Promote revascularization of the limbus• Restore the limbal cell population• Re establish the fornices

Early

• Advancement of tenon’s capsule and suturing to the limbus

• Limbal stem cell transplantation• Amniotic membrane grafting• Gluing or keratoplasty

Late

• Division of conjunctival bands and treating symblepharon

• Conjunctival grafts• Correction of eyelid deformities• Keratoplasty• keratoprosthesis

Recap

• A 22 year old female came to the opd complaining harpic solution in the right eye in the morning.

• On examination VA 6/12 and 6/6.she had chemosis and corneal oedema was present with iris visible.

Thank you