| ID | 275 |
|---|---|
| Name | Chemical Injuries to the Eye |
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| Diagnosis | |
| Investigations | |
| Management | Management: A. Emergency treatment: A chemical bum is the only type of eye injury that requires immediate treatment, without taking a detailed history. 1. Irrigation: This is crucially important in minimizing the duration of contact of the chemical with the eye & normalizing the pH as soon as possible. Ideally, normal saline irrigation for 15-30 minutes is necessary. If normal saline is not available, tap water may be used for urgent irrigation. Checking conjunctival sac pH by litmus paper time to time is important during irrigation. 2. Removal of any retained foreign particales, like lime or cement from the fomices by a cotton swab. B. Gradation of severity: Grade 1: Clear cornea & no lirnbal ischemia- excellent prognosis. Grade 2: Hazy cornea but iris details and less than l/3 of limbal ischemia-good prognosis. Grade 3: Total loss of corneal epithelium. No iris details is visible with limbal limbal ischemia of 120-180°- poor prognosis. Grade 4: As of grade 3 with limbal ischemia of > 180°- very poor prognosis. |
| Introduction | Though chemical injuries are frequently trivial, some are potentially blinding. Majority are accidental and some are as a result of assault. Important agents: 1. Alkali: Lime, ammonia, sodium hydroxide 2. Acid: Sulphuric acid, hydrochloric acid, sulphurous acid, chromic acid, hydrofluoric acid & acetic acid. Alkali burns are twice as common as acid burns. They are more dangerous & vision threatening than the acid bums, and require prolonged irrigation, since alkalies are not precipitated by the proteins of the eye or cornea. But, acids cause coagulation with the surface proteins of the cornea, thus limiting deeper penetration of the injurious agents. But, alkali tends to rapidly penetrate the eye structures & produce more severe damage to the internal parts i.e iris, lens, ciliary body etc. |
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| Etiology | |
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| Preventions | |
| Treatment | Treatment: Grade 1&2: Steroid eye drop Cycloplegics. Antibiotics. Vitamin-C 2gm orally 4 times daily + topical sodium ascorbate 10%. Tetracycline capsule orally. Tetracycline eye ointment for topical application. (Tetracycline is a collagenase inhibitor). Grade 3 & 4: Early surgery with limbal stem cell graft & amniotic membrane graft. Treatment in late presentation is complex and less rewarding. It consists of mucus membrane graft, penetrating keratoplasty & keratoprosthesis. |
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