1) Chemical eye injuries can occur in domestic, industrial, or military settings and are among the most destructive traumatic eye injuries. Alkalis generally penetrate further than acids due to their mechanisms of tissue damage. 2) Immediate and effective irrigation is crucial for chemical eye injuries, with the amount of fluid and time of irrigation depending on the substance and pH level. Neutralizing the pH through irrigation is critical even before a full examination. 3) Prognosis depends on factors like pH, duration of contact, extent of corneal involvement and limbal ischemia. More severe injuries may require long-term treatments like conjunctival grafts or keratoplasty to attempt to save vision.

1. By
Dr. Safaa Refaat
FRCSG Ophth, MSc , MBBS.

2. ‫م‬‫ح‬َّ‫الر‬ ِ‫هللا‬ ِ‫سم‬ِ‫ب‬َِِّ‫الر‬ ِ‫ن‬ِ‫م‬
”‫العامل‬ ِِّ‫رب‬ ِ‫هلل‬ ُ‫د‬‫احلم‬ ‫م‬‫ل‬ ‫وق‬‫ني‬“

3. In Chemical Eye Injury
WASH
Is Every Thing!

4. Chemical Eye Injury
Chemical injuries are among the most
destructive of all traumatic insults
suffered by the eye.
They may occur in domestic, industrial,
and military settings.

5. Alkalis (OH) cause Liquefactive necrosis and so
penetrate further than acids
Acids (H) cause Coagulative necrosis and so
impede their own progress.
But Note That: very acidic solutions may behave
like Alkalis.

6. PH
7.4
Corneal
Involvement
Duration
of Contact
Prognostic factors

7. * PH
* Duration of Contact
*Extent of Corneal Involvement
*Limbal Involvement: Re-epithelialization relies
on migration of the limbal stem cells.
*Associated nonchemical injury:
blunt trauma, thermal injury.
Prognostic factors

8. Clinical features
- Conjunctival injection or blanching,
chemosis, hemorrhage, epithelial
defects
- Corneal epitheliopathy, punctate to
complete loss, corneal edema;
perilimbal ischemia, anterior chamber
reaction
- Intra Ocular Pressure raise
- Necrotic Retinopathy.
- Eye Lids Burn and associated Facial
Burn.

9. Alkali Burn

10. Acid Burn

11. Complications
• Conjunctival scarring,
symblepharon, &
keratoconjunctivitis sicca
(Dry Eye)
• Significant limbal
ischemia:
conjunctivalization,
vascularization, Corneal
opacification

12. Complications
Corneal Melting & Perforation

13. • Full-thickness burns: hypotony,
iris, ciliary, and lenticular damage;
may progress to phthisis bulbi;
very poor prognosi
• Periorbital burns:
first-, second-, or third-degree
chemical burns of periorbital
tissues
Complications

15. Table 1: Chemical injury grading (Roper–Hall classification)
Grade Corneal appearance Limbal
ischemia
Prognosis
Grade I Clear cornea None Good
Grade II Hazy cornea:
iris details visible
<1/3 Good
Grade III Opaque cornea:
iris details obscured
1/3 to 1/2 Guarded
Grade IV Opaque cornea:
iris details obscured
>1/2 Poor

16. Table 2: Strong Alkalis in common use
Common
alkalis
Substance
Chemical P
H
Oven
cleaning
fluid
Sodium hydroxide 14
Drain
cleaning
fluid
Sodium (or
potassium)
hydroxide
14
Plaster Calcium hydroxide 14
Fertilizers
(some)
Ammonium
hydroxide
13

17. Common
acids
Substance
Chemical P
H
Battery fl
uid
Sulfuric acid 1
Lavatory
cleaning
fluid
Sulfuric acid 1
Bleach Sodium hypochlorite 1
Pool
cleaning
fluid
Sodium (or calcium)
hypochlorite
1
Table 2: Strong Acids in common use

18. Chemical Eye Burn: Managment
Early
• Minutes counts against your patient!
Don’t wait for the Ophthalmologist to
Reach
Effective
• To achieve Neutral pH,
Avarage from 2 to 8 liter is needed
IrrigationEffectiveEarly

19. Chemical Eye Burn:
First Aid At Home
Wash under running water for 20 to 45 minutes

20. Chemical Eye Burn:
First Aid At work Bath Station at our lab

21. Chemical Eye Burn:
Immediate treatment
Neutralization of pH by irrigation
* Even before a full history or detailed
examination is conducted
* Copious Irrigation in cycles of 2 litre then rest 10
min. check pH & Repeat until neutral or near-
neutral pH is confirmed by
pH/ litmus paper.
*Evert the lids to remove retained
particulate matter in fornices
(e.g., lime, cement).

22. IrrigationEffectiveEarly

23. IrrigationEffectiveEarly

25. Record & Document:
- Time started & Time Ended Irrigation
- Amount & Type of fluid used
- pH records and times they measured
- Visual Acuity
- Date & Signature of care giver
- Send to ophthalmic Department!

26. Chemical Eye Burn -
Further treatment:
• Topical antibiotics prophylaxis.
• Topical cycloplegia for comfort/AC activity
• Topical lubricants per hour.
• Oral analgesia.
Topical medication should be preservative-free when
possible.

27. • Topical steroids
• Topical & Oral ascorbic acid: essential for collagen
formation and is an effective scavenger of damaging
free radicals. (Not in acid burn)
• Systemic Tetracycline: (proteinease inhibitor & anti-
inflamatory properties)
. Antiglaucoma medications: if raised IOP:
Give acetazolamide ± topical B-blocker
Chemical Eye Burn -
Further treatment for severe injury:

28. Long-term—complicated cases
Poor corneal healing:
-conjunctival graft,
-limbal stem cell graft,
-amniotic membrane graft.
Corneal opacifi cation:
-Penetrating keratoplasty: wait
6 months, Rejection Risk.
Keratoprosthesis : for severely
damaged eyes.

29. In Chemical Eye Injury
Early & Effective
Irrigation
Is Crucial In Saving Vision!

30. THANK YOU