Adherence to Treatment and Follow-Up in Patients with Severe Chemical Eye Burns

Abstract

Introduction To investigate the demographics, acute management and compliance rates of severe chemical eye burn cases that presented to the largest eye hospital in the United Kingdom (UK). Methods All patients presenting to the Moorfields Eye Hospital emergency department are registered on the electronic patient administration system (PAS). A search of the PAS for patients assigned a preset diagnosis of ‘chemical injury’ was performed for the period from 1 January to 31 March 2016. The results of the PAS search and handwritten clerking notes were reviewed. Eyes that were found to have ≥ 33% limbal ischaemia or limbal staining, or corneal haze that obscured the details of the iris, were recorded as having severe chemical injuries. Results 55 patients had mild chemical eye burns, and 11 eyes of 10 patients had severe burns. Average patient age was 37 years (SD 22 years) and 22 years (SD 10 years) for mild and severe chemical injuries, respectively. 53% of the mild injuries and 90% of the severe injuries were in males. 7 (70%) of the 10 severe injuries were assault-related. In the severe chemical injuries group, first presentation to the emergency department was 24 h or more postinjury in 50% of the patients, 33% stopped ascorbate and citrate drops (ocular pain), 40% stopped attending clinical follow-up sessions, and 45% of the eyes had a final best corrected visual acuity (BCVA) of 6/18 or worse. Conclusion A significant proportion of the severe ocular chemical burns were assault-related. Delayed presentation and poor treatment adherence and follow-up attendance rates are significant challenges in patients with severe chemical burns. Patient education and public health awareness are important strategies. These findings also raise the question of whether these patients, who are mostly young males, should be admitted to improve treatment adherence rates and visual outcome.

Clinical characteristics of patients hospitalized for ocular chemical injuries in Shanghai from 2012 to 2017

“…In the present study, the mean age of the patients was 42.8 ± 12.7 years, which was in agreement with previous studies. Bizrah et al [14] found that the mean age of the patients with mild chemical injuries and severe chemical injuries were 37 ± 22 years and 23 ± 10 years, respectively, which were younger than our study. Men aged 18-64 years [4,10] and children aged 1-2 years [7,15] might be at the highest risk for ocular chemical injury in the workplace or residential locations due to occupational exposure and topical personal products and cleaning agents.…”

“…In our study, the majority of the patients were factory workers and construction workers, which was in agreement with the findings of Bizrah and co-workers [16]: most ocular chemical injuries were work-related. Although the delay in the presentation of 133 (83.1%) patients for medical treatment was less than 24 h after injury, only 64 (40.0%) patients were at the consultation room in less than 3 h. Bizrah et al [14] also found that 87% of patients presented to the Moorfields Eye Hospital emergency department within 24 h, but they did not state the numbers of patients in more detailed time window (e.g., less than 3 h, within 3-6 h, within 6-12 h). This suggested that the awareness of prompt treatment should be enhanced.…”

Assault-related severe ocular chemical injury at a London ophthalmic referral hospital: a 3-year retrospective observational study

“…A recent study by Bizrah and coworkers from our same institution reported 10 patients with SOCI identified over 3 months in 2016, of which seven (70%) were attributable to assault. 16 This suggests that the incidence of SOCI continues to increase and that assault-related chemical injuries continue to be a problem, with a similar proportion of assault-related injuries as in our cohort of patients.…”

“…13 It will be interesting to see if these legislative changes will translate to a reduced incidence of assault-related SOCI and further studies similar to ours and that of Bizrah and coworkers are advocated. 16 An interesting result from our study is that 40% (10/25) of our patients were lost to follow-up as they DNA subsequent review appointments. This raises several observations.…”

“…This is supported by the results form a London-based study that reported 70% of SOCI were caused by intentional injury in 2016. 16 Data on the number of assaults caused by corrosive substances since the legislative changes have yet to be published; once this is available a subsequent study looking at SOCI at our institution would be helpful to see the current trend.…”