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Chemical Eye
Trauma
By:
Dr. Amr Mounir
Elham Mahmoud Ahmed
Chemical
Eye
Trauma
Epidemiology
Chemical injuries to the eye represent about 11,5-
22%of ocular trauma,more in young males,and at
work and homes
Causes:
Duo to exposure to chemicals as acid,alkali ,gases.
Types
Strong acid
Sulphoric acid in car battery.
Hydrochloric acid in swimming pool.
Strong alkali
Potassium hydroxide in caustic potash.
Sodium hydroxide in France cleaner.
Other chemicals
Lime, Aniline dye,iodine.
The effect depends on:-
*Concentration
*Duration:-
interval between chemical trauma&1st aid
*Pathogenesis:-
it deffers according to the type as:
1-Alkali agents are lipophilic so it penetrate tissues by
saponifing the fatty acids of cell membrans and causing
pentration to the corneal stroma.
2-Acide agents coagulates and participate protiens at
the epithelium forming a physical barrier with less
penetrating effect.
Clinical picture
*Symptoms :-
Pain, lacrimation, blepharospasm,photophobia and
drop of vision.
Signs
1-Lid
Edema
Triciasis
Corneal ulcer
Cicatricial ectropion ,
Entropion, Lagophthalmos
2-Ocular surface
Dry eye
Corneal scaring,opacity,corneal melt
Symblepharon
Anterior uveitis,iridocyclitis,atrophia bulbi
Conjunctival ulcer,injection,chemosis,pseudopterygium
3-Elevated IOP
Secondary glucoma
Treatment
1-First Aid ttt
Immediate irrigation of the eye with water or
physiologic saline for 30 minutes then removal of
partcle and deprdment of necrotic tissue.
A-If the nature of the chemical substance is known :
wash the eye with proper antidote as :
-acids, NaHCO3 3%
-alkali,Boric acid lotion 4%
-iodine, starch solution or milk
-Aniline,Alcohol 10%then glycerin 10%
-Lime,use EDTA 0,1% but water not used
B-If the nature of the chemical substance is unknown:
wash the eye with either,-Tap water -Milk
2-Local treatment
-Antibiotic: tetracycline
-Atropine : for corneal ulceration&iritis
-Steroid :to decrease inflammation,corneal edema,
vascularization,scaring (1st7days )
3-ttt of complication
A -Prevention of symblepharon:
*Glass rod coated with antibiotic ointment
*Cortisone ointment
*Contact shell
*Soft CL
*Limbal stem cell transplantation,help epitheliazation
*AMG,supress fibrosis
B-2ry glaucoma
*Diamox
*Trabeculectomy in late cases
C-Lagophthalmos ,
D-Corneal opacity:
*Keratoplasty
E-Dry eye treatment
F-Surgical ttt ot trichiasis & lid
Thank you

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Chemical eye trauma

  • 1. Chemical Eye Trauma By: Dr. Amr Mounir Elham Mahmoud Ahmed
  • 3. Epidemiology Chemical injuries to the eye represent about 11,5- 22%of ocular trauma,more in young males,and at work and homes Causes: Duo to exposure to chemicals as acid,alkali ,gases.
  • 4. Types Strong acid Sulphoric acid in car battery. Hydrochloric acid in swimming pool. Strong alkali Potassium hydroxide in caustic potash. Sodium hydroxide in France cleaner. Other chemicals Lime, Aniline dye,iodine.
  • 5. The effect depends on:- *Concentration *Duration:- interval between chemical trauma&1st aid *Pathogenesis:- it deffers according to the type as: 1-Alkali agents are lipophilic so it penetrate tissues by saponifing the fatty acids of cell membrans and causing pentration to the corneal stroma. 2-Acide agents coagulates and participate protiens at the epithelium forming a physical barrier with less penetrating effect.
  • 6. Clinical picture *Symptoms :- Pain, lacrimation, blepharospasm,photophobia and drop of vision.
  • 7. Signs 1-Lid Edema Triciasis Corneal ulcer Cicatricial ectropion , Entropion, Lagophthalmos 2-Ocular surface Dry eye Corneal scaring,opacity,corneal melt Symblepharon Anterior uveitis,iridocyclitis,atrophia bulbi Conjunctival ulcer,injection,chemosis,pseudopterygium 3-Elevated IOP Secondary glucoma
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  • 12. Treatment 1-First Aid ttt Immediate irrigation of the eye with water or physiologic saline for 30 minutes then removal of partcle and deprdment of necrotic tissue. A-If the nature of the chemical substance is known : wash the eye with proper antidote as : -acids, NaHCO3 3% -alkali,Boric acid lotion 4% -iodine, starch solution or milk -Aniline,Alcohol 10%then glycerin 10% -Lime,use EDTA 0,1% but water not used B-If the nature of the chemical substance is unknown: wash the eye with either,-Tap water -Milk
  • 13. 2-Local treatment -Antibiotic: tetracycline -Atropine : for corneal ulceration&iritis -Steroid :to decrease inflammation,corneal edema, vascularization,scaring (1st7days ) 3-ttt of complication A -Prevention of symblepharon: *Glass rod coated with antibiotic ointment *Cortisone ointment *Contact shell *Soft CL *Limbal stem cell transplantation,help epitheliazation *AMG,supress fibrosis
  • 14. B-2ry glaucoma *Diamox *Trabeculectomy in late cases C-Lagophthalmos , D-Corneal opacity: *Keratoplasty E-Dry eye treatment F-Surgical ttt ot trichiasis & lid