Chemical injuries to the eye can occur through domestic, agricultural, or industrial accidents involving substances like detergents, acids, alkalis, fertilizers and insecticides. Alkali burns are more serious than acid burns. Alkalis damage cell membranes and extract water from cells, causing necrosis, while acids instantly coagulate proteins to form a barrier. Treatment involves thorough irrigation, removal of contaminants and necrotic tissue, maintenance of a favorable environment for healing, and prevention of complications like symblepharon. Later treatments may include addressing glaucoma, poor corneal healing, pseudopterygium, or corneal opacity through procedures like transplantation.

1. SONIA.S
III MBBS
CHEMICAL INJURIES OF EYE

2. MODES OF INJURIES
Domestic accidents –
Eg :detergents,cosmetics
Agricultural accidents-
Eg;fertilizers,insecticides
Chemical laboratory accidents-
Eg:acid and alkalies
Delibrate chemical attacks with acids and
alkalies
Chemical warfare injuries
Self-inflicted chemical injuries are seen in
malingereres and psychopaths

3. TYPES
 In general ,the serious chemical burns
mainly comprise
Alkali burns
Acid burns

4. ALKALI BURNS
 MECHANISM OF DAMAGE PRODUCED :
1. Alkalies dissociate and spongify fatty acids of
the cell membrane and destroy the structure of
cell membrane of the tissue.
2. Being hygroscopic , they extract water from the
cells, a factor which contributes to total
necrosis.
3. They combine with lipid cells to form soluble
compounds, which produce a condition of
softening and gelatinisation.
 Thus alkali spread widely ,their action lasts for
some days .Hence , prognosis in such cases
must always be guarded.

5. CLINICAL PICTURE
 STAGE OF ACUTE ISCHEMIC NECROSIS
CONJUNCTIVA shows marked odema,
congestion,widespread necrosis and a copious
discharge.
CORNEA developed widespread sloughing of the
epithelium ,odema opalescence of the stroma.
IRIS becomes violently inflamed and in severe cases
both iris and ciliary bodies are replaced by granulation
tissue.
 STAGE OF REPARATION
In this stage conjunctival and corneal epithelium
regenerate ,there occurs corneal vascularization and
inflammation of the iris subsides.
STAGE OF COMPLICATION
This stage is characterised by development of
symblepharon ,recurrent corneal ulceration and

6. ACID BURNS
 Acid burns are less serious than
alkali burns .
 CHEMICAL EFFECTS:
The storng acid causes
instant coagulation of the proteins
which then acts as a barrier and
prevent deeper penetration of acid
into the tissue.
thus ,lesion becomes sharply

7. OCCULAR LESIONS
 CONJUNCTIVA There occurs immediate necrosis
followed by sloughing . Later on symblepharon is
formed due to fibrosis.
 CORNEA. It is necrosed and sloughed out
.Extent of damage depends on concentration of
acid and duration of contact.
 In severe cases , whole cornes may be slough
out followed by staphyloma formation.

9. TREATMENT
 IMMEDIATE AND THROUGH IRRIGATION with the
available clean water or saline through IV tubing
.minimum 2l of water till pH is restored.
 MECHANICAL REMOVAL OF THE CONTAMINANT if
any particles are left behind , particularly in case of
lime.
 REMOVAL OF CONTAMINANT AND NECROTIC
TISSUE necrosed conjunctiva should be excised .
Contaminated and necrosed corneal epithelium
should be removed with a cotton swab.
 MAINTENANCE OF FAVOURABLE CONDITIONS for
rapid and uncomplicated healing by frequent
application of topical atropine , corticosteroids,
antibiotics and lubricants .
 PREVENTION OF SYMBLEPHARON can be done
by using a glass shell or sweeping a glass rod on
fornices daily.

10. TREATMENT OF COMPLICATIONS
SECONDARY GLAUCOMA should be treated with
topical 0.5% timolol , installed twice a day along
with oral acetazolamide 250mg 3-4 times aday.
POOR CORNEAL HEALING WITH LIMBAL STEM
CELL DEFICIANCY may be treated by amniotic
membrane transplantation with or without limbal
cell transplantation.
PSEUDOTERYGIUM when formed should be
excised with conjunctival auto graft or amniotic
membrane facilitated by antimitotic drugs

11.  TREATMENT OF SYMBLEPHARON
 CORNEAL OPACITY may be treated by
keratoplasty if adequate tear film and stem cell
population available.
 KERATOPROSTHESIS remains a surgical option
in severly damaged eyes.

13. REFFERENCES
 Parsons’ Diseases of eye.
 Textbook of ophthalmology by khurrana