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At least 19 recordsLinked to original sources
PubMed2004

[Physiopathology of eye burns].

Eye burns are frequent among eye traumas. They induce different effects on the ocular structures, depending on the type of burn: chemical, with an important difference between acids and bases, thermal, or ionizing rays. The physiopathology of eye burns reflects the different stages of progression, with a first stage of destruction, a second stage of cleaning and inflammation, and a last stage of reconstruction and scarring. The final prognosis depends on the initial lesions, not only involving the eye ball, but also the conjunctiva and eyelids. Chemical burns by basic fluids have the worst prognosis because they are able to penetrate the tissues quickly. Burns by acids have a better prognosis and thermal burns are located only at the injured area. Treatment is most effective at the initial stage of destruction and can dramatically change the prognosis. The secondary phase of cleaning includes the entire biochemical cascade of inflammation and the production of proteases. At this stage, treatment can be effective but must be closely monitored because it can inhibit progression to the last stage of scarring. At the scarring stage, neovascularization begins, induced by initial ischemia, the reconstruction of epithelium with a probable role of stem cells, the reconstruction of nerve fibers depending on the nerve growth factor (NGF), and the reconstruction of extracellular matrix in which matrix metalloproteinases (MMPs) are essential. At this stage, therapy can only be surgery of functional after effects and esthetic anomalies.

Eye Burns↗
PubMed1993

[Keratoplasty with 11-12 mm diameter for management of severely chemical-burned eyes].

Up to now 73 patients with 101 very severe eye burns have been operated on in our clinic. Thirty-nine patients were treated by a penetrating keratoplasty. More than 1 year after the accident 8 patients were treated with keratoplasties, 11-12 mm in diameter. These large diameters were necessary, because 6 patients developed widespread progressive corneal ulcerations, and in 2 patients the artificial epithelium failed to protect the denuded corneal stroma and sloughed off because of deep stromal defects. The long-term follow-up in these cases is now at least 1 year. Six grafts remained clear with a healthy epithelial layer. The resulting visual acuity in these cases ranged from 0.1 to 0.5. Five patients developed a cataract secondary to the application of steroids. Two grafts were rejected in a very early period 2-3 months after transplantation. In corneal melting processes including the limbal region, treatment with large keratoplasties seems to be a possibility for long-lasting healing and rehabilitation in very severe eye burns. Important for the prognosis of the graft obviously is the restoration of an intact limbal region.

Adolescent↗
PubMed2006

Corneal calcification after chemical eye burns caused by eye drops containing phosphate buffer.

PURPOSE: Chemical burns with calcium containing corrosives as well as irrigation with phosphate buffer solutions after eye burns bear the risk of corneal calcification. The aim of this study was to evaluate the correlation between the occurrence of corneal calcification after chemical injuries and the usage of phosphate buffer containing local therapeutics. METHODS: We reviewed the data of 179 patients who have been treated in the University Eye Clinic Aachen, Germany, between 1941 and 2000. Only when the corrosive did not contain calcium and when the initial irrigating solution did not contain phosphate buffer, respectively, were patients included in the study. The cases were analyse, if the patient was treated with phosphate buffer containing eye drops/ointment during the first 7 days of hospitalization or as an out-patient, and if corneal calcification was visible by slit-lamp examination during the follow-up. Statistical analysis was performed using Fischer's exact test. RESULTS: 152 eyes were included. From 63 eyes treated with phosphate buffer containing eye drops, 31 eyes (49%) developed corneal calcification. From 89 eyes treated without phosphate buffer containing eye drops, only 23 eyes (26%) developed corneal calcification. The two-sided p-value of Fischer's exact test is 0.0036. CONCLUSION: During follow-up after chemical eye burns, eye drops containing phosphate buffer double the risk of corneal calcification. We recommend avoiding these agents in order to prevent the burned cornea from additional opacity. Substances containing phosphate buffer are listed in this article.

Buffers↗
PubMed1995

[Tenon-plasty and early keratoplasty in severe chemical eye burns].

In severe eye burns with destruction of extensive areas of the conjunctiva and epibulbar tissue, Tenon plasty has proved to be successful. Because the epithelium fails to cover the denuded stroma, the corneal surface must be protected by an artificial epithelium. If necrolysis occurs, a tectonic keratoplasty must be performed early. The clinical courses of 12 patients with 14 very severely burned eyes are reported. In addition to Tenon plasty, early penetrating keratoplasies with large diameters 10-16 mm were performed up to 3 months after the accident. The follow-up time was between 6 and 34 months (mean 15.1 months). In five cases the Tenon tissue showed marked inflammation, and the keratoplasties developed large, persistent epithelial defects and had to be covered by conjunctiva. In the other cases it was possible to preserve a healthy epithelial layer by applying soft contact lenses. In 79% of the cases an endothelial graft rejection was observed. In about 50% the transplants were lost. Early keratoplasties are mainly for tectonic repair in severely burned eyes. Optical rehabilitation was achieved in only a few cases.

Adult↗
PubMed1999

[Prospective study of eye burns at the Fort de France University Hospital].

PURPOSE: We report the results of a three-years prospective study focusing on ocular alkali burns conducted in the University hospital of Fort de France (French West Indies). PATIENTS AND METHODS: This case record survey included all alkali burns evaluated by ophthalmologists in the emergency unit of the Fort de France hospital. All recruited patients were either called to identify the alkali (pH determined with a Prolab pH-meter) or underwent an anterior chamber puncture showing evidence of an aqueous humor pH above 8. The recorded data were: age, gender, cause of burn, in case of aggression the relation between the victim and the aggressor, initial clinical findings, Ropper Hall classification. The therapeutic protocol was initiated according to this classification. The course of the ocular burn was noted. Economical and medicolegal consequences were assessed from duration of off work time and from information provided by the public prosecutor respectively. RESULTS: Twenty-four patients who had 39 burned eyes were included. Most ocular burns (18) were caused by aggressions with Alcali (ammonia, pH = 12.8). Most victims were men accused of adultery. In the West Indies, Alcali is thought to have power to drive away evil spirits. Most victims were young men (mean age 42 years). Eight court suits have been filed and in 5 cases the judge dismissed the charge. In 13 eyes, the delay to the first ocular wash was 30 minutes and resulted in serious ocular burn (Ropper Hall class 3 or 4). After application of the therapeutic protocol, 6 of these eyes recovered in an average 55 days; 3 required limbal autograft, 2 were successful. Three of these severe burns were complicated by spontaneous perforation (1 eye), atrophy (1 eye), and leucoma (1 eye). One patient was lost to follow-up. All minor ocular burns (Ropper Hall class 1 and 2) healed within an average 12 days (range 3-38 days). CONCLUSION: Particular circumstances of ocular alkali burns in Martinique (French West Indies) have been indentified in this study which established the seriousness of these burns and their social and sometimes legal consequences. The importance of prevention is emphasized. It would seem that minor ocular alkali burns do not require a treatment duration longer than 15 days. Finally, the clinical data reported in this study show that a delay of several minutes is required for the development of severe ocular alkali burns.

Adult↗
PubMed1996

[Keratoplasty with scleral rim after the most severe chemical eye burns of the anterior eye segment].

BACKGROUND: Corneo-scleral ulcerations and perforations are severe complications after most severe eye burns. One possibility to handle this situation is a keratoplasty with a scleral rim. This retrospective study was carried out to show the outcome after total replacement of the cornea after most severe eye burns. PATIENTS: Between 1986 and 1991 we carried out 12 keratoplasties with a scleral rim in 9 most severely burnt eyes of 7 patients. In 9 cases this intervention was the first transplantation. In 3 eyes a re-keratoplasty had to be carried out. RESULTS: All eyes could be saved after this surgical intervention, although all but two transplants failed. In eight cases the transplant decompensated and/or was replaced by scar tissue. Two transplants remained clear. Visual acuity was light perception in five cases, intact light projection in two cases, 1/35 in one case because of cataract formation and 0.8 in another case at the end of the observation period. The reasons for graft failure were multifactorial. Epithelial problems were the reason for graft failure in eight cases. Two of these also showed shrinkage of the eye lids with incomplete lid closure. In six cases severe vascularisation with scar formation was observed. It is remarkable that immunoreactions occurred only in four cases. This may be due to the fact that all patients were treated systemically with cyclosporin A. In one case the transplant failed after extensive surgery of the anterior segment. CONCLUSION: Our results show that the keratoplasty with a scleral rim can save the eye in the difficult situation of corneo-scleral ulceration or perforation. Nevertheless a visual rehabilitation could not be achieved in seven of nine cases. But all eyes were in a satisfying condition for further smaller transplants to achieve better visual acuity.

Accidents, Home↗
PubMed2004

[Acute therapy for eye burns].

BACKGROUND: Eye rinsing is the major therapeutic measure with a decisive impact on prognosis after chemical or thermal eye irritation. Several different major targets are addressed by this measure. AIM OF THE STUDY: Up to now emphasis in research was placed mostly on the neutralisation of chemical products. Newer experimental results on the basis of biological experiments interpreted against the background of basic chemical reactions may enhance clinical treatment by introducing new mechanisms of intervention. MATERIALS AND METHODS: Experiments on the modification of osmolarity, buffering capacity and solubility products show new possibilities of therapy in eye rinsing after eye irritation. These mechanisms are demonstrated by means of key experiments. RESULTS: The official recommendation of rinsing a burnt eye with water seems to be insufficient against the background of actual experimental data. Measurements of pH after eye burns indicate no buffering effects for water, or aqueous saline solution. There was weak buffering for phosphate buffer in alkali burns and a high capacity for neutralisation for diphoterine in alkali and acid burns. Ionic contents and osmolarities of the rinsing solutions have a decisive influence on the ionic composition and osmolarity of the burnt cornea after rinsing. Cellular damage is enhanced in unaffected healthy cell cultures by hyposomolar rinsing. CONCLUSION: We recommend buffered solutions with high buffer capacities for initial eye rinsing. The advantage or disadvantage of the elevated concentration of ions in the buffered rinsing solutions determining osmolarity cannot be confirmed or refuted up to now. It seems to us to be certain that osmolarity is a decisive future factor in initial rinsing.

Acute Disease↗
PubMed1988

Clinical application of epiderm growth factor in patients with most severe eye burns.

20 eyes of 11 patients suffering from most severe eye burns of grade 4 or worse were treated in addition to various other drugs with epiderm growth factor (EGF) or placebo in a double-blind test. Among 10 eyes treated with EGF, 6 achieved complete regeneration of the corneal epithelium, and 1 additional case, of the conjunctival epithelium. Among the eyes receiving placebo, only 3 out of 10 healed; all of them were also treated with fibronectin. Although in these very difficult cases EGF could not be investigated as a single therapy, and various other undefined factors may have been effective, in the extended course of the disease the period of EGF treatment was marked by a significant better regeneration of the epithelium.

Burns, Chemical↗
PubMed1997

Video fluorescein angiography of the anterior eye segment in severe eye burns.

PURPOSE: Severe eye burns often result in extensive necrosis of the conjunctiva and episcleral tissue. Video fluorescein angiography was performed to reveal the perfusion of the anterior eye segment after severe eye burns. METHODS: A scanning laser ophthalmoscope was used for anterior segment fluorescein angiography in 12 patients (14 eyes) with severe burns grade III-IV and in 7 healthy volunteers. RESULTS: Necrotic tissues occurred as non perfused areas and remained dark throughout the whole angiogram. In general, the borders from healthy to necrotic conjunctival tissue were sharply demarcated. Thus, the extent of scleral and limbal ischemia could be determined exactly. Injured vessels showed hyperfluorescence with late leakage. Damage of the subconjunctival tissue appeared as a deep weak fluorescence in the early angiography and exhibited patchy leakage in the late angiogram. CONCLUSIONS: Anterior segment angiography provides a basis for deciding the extent of surgical debridement of necrotic tissue in the acute phase of the burn. The determination of the extent of limbal and scleral ischemia may give useful information for early plastic-reconstructive procedures.

Adult↗
PubMed2002

Emergency treatment of chemical and thermal eye burns.

Chemical and thermal eye burns account for a small but significant fraction of ocular trauma. The speed at which initial irrigation of the eye begins, has the greatest influence on the prognosis and outcome of eye burns. Water is commonly recommended as an irrigation fluid. However, water is hypotonic to the corneal stroma. The osmolarity gradient causes an increased water influx into the cornea and the invasion of the corrosive substance into deeper corneal structures. We therefore recommend higher osmolarities for the initial rinsing to mobilize water and the dissolved corrosives out of the burnt tissue. Universal systems such as amphoteric solutions, which have an unspecific binding with bases and acids, provide a convenient solution for emergency neutralisation. Both conservative anti-inflammatory therapy and early surgical intervention are important to reduce the inflammatory response of the burnt tissue. In most severe eye burns, tenonplasty re-establishes the conjunctival surface and limbal vascularity and prevents anterior segment necrosis.

Burns, Chemical↗
PubMed1996

[Consensual inflammatory reaction in chemical eye burn of the rabbit eye].

BACKGROUND: Consensual ocular response has been known to occur following intracranial stimulation of the trigeminal nerve, intracameral injection of prostaglandins and other substances, after paracentesis and contusio bulbi. MATERIAL AND METHOD: We have examined the prostacyclin formation in both eyes after experimental alcali burn (0.25 mo/l NaOH) on 30 rabbits with ELISA over a follow up period of 14 days. RESULTS: After the alcali burn the aqueous prostacyclin level on the right eye is increased from 327 pg/ml aqueous to 27098 pg/ml aqueous, but on the left it stays normally. In conjunctiva and anterior uvea we measured normal amounts of prostacyclin. CONCLUSIONS: We could not find a consensual increase in prostacyclin formation in the anterior part of the fellow eye following alcali burn.

Animals↗
PubMedDate not supplied

[Necrolytic properties of alkaline protease in the treatment of severe eye burns].

Both eyes of 62 rabbits (124 eyes) were experimentally studied. Necrolytic properties of alkaline protease were examined on a model of an isolated alkaline retinal burn by 10% NaOH with a 10 sec exposure; the protease optimal concentration and an optimal exposure were determined. It was established that a necrolytic effect correlating with that of lecozyme can be achieved when a protease solution with an activity of 25-27 PE is used. An increased activity of protease in the solution results not only in hydrolysis of the turbid corneal part, but it also melts the perifocal area entailing a danger of perforation. Alkaline protease can be used as an ointment to ensure the necrolytic effect, however, its dosage in such medication form must be above 30-35 PE. The administration of a preliminary enzymatic necrectomy produced a positive effect on the postoperative cause and the results of keratoplasty as compared with surgical necrectomy, which can be explained by a better quality necrectomy involving the use of alkaline protease.

Animals↗
PubMed1997

Tenonplasty: a new surgical approach for the treatment of severe eye burns.

BACKGROUND AND OBJECTIVE: In the acute stage of most severe eye burns, the primary goal is survival of the globe. Initial tissue destruction may lead to extensive necrosis of the conjunctiva and underlying tissue down to the fornices, with resulting ischemia. These circumstances may cause a polymorphonuclear cell response, with resulting corneo-scleral ulceration and early melting of the globe. To reestablish the ocular surface, Tenonplasty was performed as a plastic procedure to reconstruct the conjunctival matrix of the globe up to the limbus. PATIENTS AND METHODS: Vital Tenon's sheets from the orbital region were prepared and advanced up to the limbus to cover the ischemic or ulcerating sclera with healthy, vascularized tissue. Fifty-nine patients with 75 severely burned eyes were treated with this procedure between 1987 and 1994. A total of 243 Tenon's flaps were prepared. RESULTS: In all cases, scleral ulcerations were prevented or healed. Epithelialization of the advanced Tenon's sheets was complete within 21 days in 80% of the cases and in all eyes within 54 days. Primary epithelialization of the burned cornea was achieved in approximately 31% of the cases. Fornices were sufficiently deep in about 74%, but severe symblepharon formation occurred in 26% of the cases. CONCLUSION: Tenonplasty may be an alternative surgical procedure to transplantation of autologous conjunctival or mucous grafts in restoring the conjunctival surface of the globe in severely burned eyes.

Adolescent↗