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Ocular Emergency

Chemical Injuries
Non-Mechanical Injuries
Chemical Injuries

• Mainly comprise of alkali and acid burns


Modes of chemical injury
Domestic accidents Ammonia, solvents, detergents &
cosmetics
Agricultural accidents Fertilizers, insecticides, toxins of
vegetable & animal origin
Chemical laboratory accidents Acids and alkalies
Deliberate chemical attacks Acids to disfigure the face
Chemical warfares injury -
Self-inflicted chemical injury Seen in malingerers & psychopath
Alkali Burns
Alkalies dissociates & saponify fatty
• Most severe chemical acids of cell membrane
injuries (Destroy structure cell membrane)

Common Alkalies
Being Hygroscopic  extract water
•Lime (CaO) from cell  total necrosis
•Caustic Potash/ Caustic
Soda (KOH)
•Liquid ammonia They Combine with lipids of cell 
form soluble compound
(softening & gelatinization)

Increased deep penetration


of alkalies into tissues
Clinical features
1. Stage of acute ischaemic
necrosis
• Conjunctiva : marked edema,
congestion, copius purulent
discharge
• Cornea : widespread sloughing
of epithelium, edema
• Iris : inflamed

2. Stage of reparation
• Conjunctiva and cornea regenerate
• Corneal vascularization
• Inflammation subsides

3. Stage of complications
• Development of symblepharon, recurrent corneal ulceration, complicated cataract,
secondary glaucoma
Acids Burn
• Less serious than alkali • Chemical Effect
burns
Instant
coagulation of
all proteins
Common acid
•Sulphuric acid
•Hydrochloric acid
Act as barrier
•Nitric Acid

Prevent deep
penetration of acid
into tissue
• Clinical features
– Conjuntiva

Immediate Symblepharon
Sloughing
necrosis (fibrosis)

– Cornea
• Necrosis and sloughed out

Mild to • Corneal
opacification of
moderate varying degree

• Whole cornea may


Severe slough out
 staphyloma
Roper-Hall classification
--Grades of chemical burns--
Visual
Grade Corneal Appeareance Limbal Ischemia
Prognosis

I • Clear cornea Nil Excellent

• Hazy
II <1/3 Good
• Iris details visible

• Opaque cornea Doubtful/


III 1/3 to half
• Iris details obscured Guarded

• Opaque
IV • No view of iris and >half Poor
pupil
Treatment
• Prevent further damage
– Immediate and thorough irrigation with clean
water or normal saline
• NS (2L) for 20-30 min or until achieve normal pH
– Mechanical removal of contaminant using swab
stick
– Removal of contaminated & necrotic tissue
• Maintenance of favourable condition
(rapid & uncomplicated healing)
– Topical antibiotics drops (moxifloxacin 4-6 per
day)
– Steroid eyedrops
– Cycloplegics (atropine)
– Ascorbic acid (in form of 10% sodium ascorbate
eyesdrops)
– Lubricant eyedrops
– Autologous serum
– Sodium citrate ( 10% Topical eyedrops)
– Doxycycline 100 mg BD
• Prevention of symblepharon
– Slide piece of glass in between
the 2 surfaces for 2-3 times/day
until inflammation subside

• Treatment of complication
– Secondary glaucoma
– Poor corneal healing
– Pseudopterygium
– Symblepharon
– Corneal opacity
Non-mechanical Injuries

Thermal
Electrical
Radiation
Thermal Injuries
• Usually caused by fire / hot
fluids
• Severe case, conjunctiva &
cornea may be affected

Treatment:
• If only lids, general
treatments of burns
• If cornea, treated with
atropine, steroids,
antibiotics & lubricants
Electrical Injuries
• Caused by passage of strong current from
the area of eyes

• Clinical features :
• Congested conjunctiva
• Cornea : punctate / diffuse interstitial
opacities
• Inflamed iris & ciliary body
• May develop ‘electric cataract’ after 2-4
months
• Multiple hemorrhages on retina
• May develop optic neuritis
Radiational Injuries
1. Ultraviolet radiations :
• may cause photopthalmia &
responsible for senile cataract
2. Infrared radiations :
• may cause solar macular
burns
3. Ionizing radiations :
• following radiotherapy to the
tumors in the vicinity of the
eyes (keratoconjunctivitis,
dermatitis of lids, cataract,
retinopathy)