Corneal and Conjunctival Burns

The degree of damage to the cornea and conjunctiva from acid or alkali etching depends on the exposure time and the concentration of the caustic.

  • the acids cause coagulation necrosis , which prevents deep damage to the cornea
  • the principles cause colliquative necrosis , which goes deep and causes more serious injury

The most common substances that cause burns

    • lime
    • sulfuric acid
    • hydrochloric acid

Injury Description

    • minor injuries cause necrosis of the corneal epithelium and occlusion of the perilimbal vessels, which prolongs or hinders healing
    • severe injuries cause necrosis of the cornea and sclera

Visible changes

  • pseudopterygium – a fibrovascular membrane that grows over the clouded cornea
  • symblepharon – adhesions between the lid and bulbar conjunctiva as a result of conjunctival scarring
  • ectropion – scarring causes the edge of the lids to turn away from the bulb
  • trichiasis – eyelashes turn against the bulb and thereby traumatize the conjunctiva and cornea
  • inflammatory uveal reaction
  • secondary glaucoma

Degrees of etching

    • 1st degree : congestion of the eyelids, conjunctivae, mucous secretion, erosion of the eye surface (heals ad integrum)
    • 2nd degree : previous signs, in addition blisters and the formation of ischemic foci (small corneal opacities remain, possibly symblepharon)
    • 3rd degree : skin necrosis, ischemic changes, vessel occlusion, boiled fish eye - clouded cornea (prolonged healing, dry eye, corneal vascularization)
    • 4th degree : charring (loss of the eye)

First Aid

    • remove the caustic with any suitable solution
    • mechanically clean the eyelids, cornea, conjunctivae
    • transfer to the eye clinic: prevent secondary infection - application of ATB, corticosteroids (used only in the first phase of healing)
    • treatment of eyelid position, symblefares, pseudopterygia, trichiasis
    • in case of damage to the lacrimal apparatus and lack of tears, the application of artificial tears


References

  • ROZSÍVAL, Pavel, et al. Ophthalmology. 1st edition. Prague: Galén, 2006. 373 pp.  ISBN 80-7262-404-0 .