Chemical eye injury: pathophysiology, assessment and management

Abstract

Chemical eye injury (CEI) is an acute emergency which can threaten sight and life. These commonly occur at home or the workplace with the former being generally mild and the latter more severe and bilateral. Major workplace accidents involve other parts of the body and can be associated with inhalation or ingestion of the chemical. Alkali injuries cause damage by saponification of tissue and deeper penetration as a consequence. Acid injuries cause rapid coagulation of tissue, which impedes penetration and limits damage. Irritants such as alcohols, cause superficial epithelial denudation. Severe chemical insult can affect all anterior segment structures causing iris, pupil and lens abnormalities. Eye pressure is variably affected and can be low or high or start as one and rapidly change to the other. Chorioretinal changes in the form of vasculopathy are seen and ascribed to be secondary to anterior segment inflammation rather than due to the direct effect of CEI. Final outcome related to structure and function is determined by the injurious agent, duration of exposure, nature of treatment and the rapidity with which it is instituted. Prevention of further damage by profuse and prolonged eye wash, after ascertaining pH of both eyes, together with exploration and removal of all particulate matter, is the key. Other management principles include a complete and thorough assessment, control of inflammation, facilitation of healing and prevention and management of sequelae and complications. Intraocular pressure is often forgotten and must be assessed and managed. Management often requires a multidisciplinary approach.

Longitudinal Assessment of Alkali Injury on Mouse Cornea Using Anterior Segment Optical Coherence Tomography

“…Ocular burn assessment by the Roper Hall or Dua classification system allows prognostic chemical eye injury grading 2,24 ; however, these two systems rely on objective measurements of corneal ischemia and opacity alone. [25][26][27] With the new insights obtained from the current study, perhaps a dose-response ocular chemical injury model can be designed to augment the existing ocular burn grading system using AS-OCT/OCTA systems.…”

Evaluation of Clinical and Histological Outcomes of Adipose-Derived Mesenchymal Stem Cells in a Rabbit Corneal Alkali Burn Model

“…To our knowledge, corneal aesthesiometry measurements using the Cochet-Bonet aesthesiometer have not been reported in the literature in cases of chemical burns. It is an important factor in the overall clinical assessment of a patient with a chemical burn, and it should be assessed when the effect of the anesthetic drops (after the initial irrigation) has worn off [31]. In our opinion, the favorable results in terms of the improvement in the central corneal sensation noted in the treatment group are promising as they would be beneficial concerning the outcome of subsequent corneal surgery in the form of a keratoplasty.…”

Clinical Spectrum and Outcomes of Ocular and Periocular Complications following External-Beam Radiotherapy for Inoperable Malignant Maxillary Sinus Tumors

“…AMT promotes corneal epithelialization and exhibits anti-inflammatory, antifibrotic, antiangiogenic, and antimicrobial properties [25]. It has been used to treat persistent epithelial defects, chemical eye injury, Steven-Johnson syndrome, infectious keratitis, corneal perforation, bullous keratopathy, LSCD, conjunctival reconstruction, and DED [25][26][27][28]. Future studies evaluating the prophylactic role of AMT in reducing the risk and severity of radiation keratopathy after highdose orbital/periorbital EBRT will be valuable.…”