Chemical Injury & Foreign Body Ocular Injury , G S MEDICAL COLLEGE, DR M SAQUIB

1. OCULAR INJURY – Open & Chemical
25th August 2020
DR M SAQUIB
Vice Principal
MBBS,MS , FSCEH DELHI,FHVDESAI PUNE,
EX REGISTRARA JNMCH,AMU
CONSULTANT OPHTHALMOLOGIST
HOD D/O OPHTHALMOLOGY
G.S .MEDICAL COLLEGE
Founder sec: MEDICS India ,
Mail-dms2k5@gmail.com , 9634123800

2. TRAUMA
EYE LID TRAUMA
Laceration
Periocular Haematoma
ORBITAL FRACTURE
Blow out orbital fractures
GLOBE TRAUMA
Blunt Trauma
Penetrating Trauma
Foreign Body
Shaken baby Syndrome
CHEMICAL INJURIES2

3. Penetrating Trauma
▸ Young ,
▸ Male
▸ Assault ,Accident ,Sports injury
▸ Kinetic Injury of object determine
considerable injury
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4. Mechanism of Damage
▸ Mechanical effect
▸ Infection –
Abscess, Endophthalmitis, Panophthalmitis
▸ Iridocyclitis – Sympathetic ophthalmitis
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5. ▸ Wound of Conjunctiva
▸ Wound of Cornea
▸ Wound Sclera
▸ Wound of the lens
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6. Traumatic
Tractional Retinal Detachment
▸ Penetrating Injury
▸ Vitreous Prolapse & Haemorhage
▸ Vitreoretinal proliferation
▸ Tractional band
▸ Tractional RD
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7. Penetrating wounds with the Retention of
Foreign Bodies
▸ Damage by
▸ Mechanical Effect
▸ Introduction of Infection
▸ Specific action
(Chemical or otherwise )
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8. Non -Organic material
▸ Gold ,Plastic ,stone ,Glass
▸ Lead – Gun powder
▸ Aluminium –
▸ Zinc
▸ Iron
▸ Copper
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10. ▸ Siderosis is a complication due to a magnetic
intraocular or intraorbital foreign body.
▸ Generally metals with a low redox potential, such
as Fe++and Cu++, have the greatest potential for
metallosis.
▸ Siderosis may develop within weeks, but the
course is variable depending on the iron content
in the foreign body and its location.
▸ Virtually all ocular structures are involved in the
siderotic process—Glaucoma, Cataract, iris color
changes, mydriasis, retinal function destruction,
and optic nerve atrophy.
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11. Iron Foreign body
▸ Iron intraocular foreign bodies can result in
siderosis bulbi, a condition characterized by
deposition of iron molecules in the trabecular
meshwork, lens epithelium, iris, and retina .
▸ Iron make chemical combination with Protein of
the cells and produce degenerative changes .
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13. Lens
▸ In siderosis or hemosiderosis the lens epithelium
takes on a yellow-brown or rusty appearance from
minute dots of intracellular iron, identifiable by Perls'
or other iron stains.
▸ Focal rusty-brown nodules of subcapsular cataract
may develop. When the foreign body is in the lens
there may be progression to a mature cataract, with
diffusion of ionizable iron throughout the lens fibers.
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15. Retina
▸ The iron concentrates mainly in RPE and inner
limiting membrane neurosensory retina. Necrosis of
the photoreceptor cells occurs over large areas of
the retina.
▸ Functional damage to the retina occurs at a very
early stage, before extensive siderosis is apparent,
and before stainable iron is detected in retinal
tissues.
▸ Retinal degeneration with attenuated blood vessels
▸ ERG- Increased amplitude of the a-wave with
normal b-wave . Advanced cases b wave diminishes15

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17. ▸ Heterochromia iridis- Staining of Iris greenish
–Reddish to brown .
▸ Mydriasis- Deposition of Iron in the sphincter
of the Iris leads to Mydriasis .
▸ Secondary Glaucoma
▸ Prussian Blue reaction
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18. Chalcosis
▸ Alloy of copper causes specific
changes
▸ Electrolytic dissociation &
deposition in membrane
▸ Pure copper cause violent reaction
▸ Suppurative Reaction
▸ Fibrosis …. Globe shrinkage18

19. Chalcosis : Copper /Brass
Kayser-fleischer Ring- Copper deposition in
descmet’ membrane of peripheral cornea ,Golden
brown ring
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20. Sunflower Cataract Deposition of copper
under posterior capsule of lens.
▸ Golden green in Colour , Arranged like petals of flower
▸ Retina : Deposition of Golden plaques at the
posterior pole which reflect the light with a
metallic sheen20

21. Organic Material
▸ Leaves, Fonds, Thorns , Woods, Vegetables ,
Eyelashes , Caterpillar hair
▸ Granulation Tissue
▸ Fungal Infection
▸ Caterpillar – Iridocyclitis – ophthalmia nodosa
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23. Diagnosis
▸ Detail History
▸ Mode of Injury
▸ Hammer chisel injury look for Entry wound
▸ Slit Lamp Examination
▸ Anterior segment
▸ Angle – Gonioscopy
▸ Radiography – X ray – Caldwell & Lateral view
▸ Metal ring suturing at limbus X ray for localisation
▸ CT – 2mm > slices
▸ USG – B scan
▸ MRI
▸
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25. Treatment –
▸ Surgical Removal
▸ Unless- Inert ,Little Damage , Removal Is
Dangerous For Sight .
▸ Metallic / Magnet Foreign Body – Surgical ,
Magnet Can Be Used
▸ Followup
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26. Sympathetic Ophthalmitis
▸ Rare bilateral granulomatous inflammation that follows
accidental or surgical insult to the uvea of one eye.
▸ Onset -insidious or acute, with recurrent periods of
exacerbation.
▸ Clinical presentation –Loss of accomodation.DOV ,9 days-9
year mutton-fat keratic precipitates, choroidal infiltrations,
and Dalen-Fuchs nodules.
▸ Histopathology reveals diffuse or nodular granulomatous
inflammation of the uvea.
▸ Prevention and treatment: enucleation of the injured eye
and immunosuppressive therapy, aimed at controlling
inflammation.
▸ The etiology and pathophysiology of the disease is still
unclear autoimmune in nature.26

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28. Chemical Injuries
▸ Alkalies –Caustic , Lime ( Fresh mortar , white
wash ) , Ammonia , Sodium Hydroxide
▸ Acidic –Hydrochloric , sulphuric acid
Mode of Injury :
▸ Domestic accident
▸ Agriculture accident – Fertilisers, Insecticide
▸ Chemical laboratory accidents
▸ Deliberate chemical attacks
▸ Chemical warfare Injury
▸ Self Inflicted chemical Injury28

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Alkali Burn Acid Burm
Lime ,Caustic Potash , Caustic Soda , Liquid
ammonia
Sulphuric, Hydrochloric , Nitic acid
Saponification of fatty acid of the cell
membrane
Necrosis –
Gelatinisation -
Instant coagulation of all protein , make barrier
for further penetration
Penetraion of Alkali to deeper tissue and for
longer period .
Superficial tissue ,line of demarcation
Stages Acute Ischemic Necrosis-
Inflammation,Edema , Discharge of
conjuctiva,Cornea, Iris
Reparation –Regeneration,Vascularisation
Complication –Symblephron ,Recurrent
corneal ulcer , Complicated cataract
,Glaucoma
Conjuctiva -Necrosis ,Sloughing , Symblephron
Corneal edema
Sloughing , opacification , Staphyloma

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34. Treatment
▸ Prevent Further
Damage
▸ Irrigation – 2 Litre –
Clean water or saline
▸ Contaminant
Removal , Necrosed
Conjunctiva removal
.
▸ Support Healing and
Prevent Inflammation
& Infection34

35. ▸ Antibiotic Eye Drop
▸ Steroid Eye drop
▸ Cycloplegic – Atropine eye drop
▸ Lubricant Eye drop
▸ Autologous serum
▸ Ascorbic acid
▸ Tab Doxycycline 100 mg bd
▸ PREVENTION OF Symblepahron –Glass shell ,
Sweeping glass rod
▸ Treat Complication – AMG with or without stem cell
transplantation , Glaucoma , Keratoplasty ,
Keratoprosthesis
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