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Alkali-Related Ocular Burns: A Case Series and Review

Bunker, Daniel J.L. MBBS*; George, Robert J. MB, ChB*; Kleinschmidt, Andrew FRANZCO; Kumar, Rohit J. MBBS*; Maitz, Peter FRACS

Journal of Burn Care & Research: May/June 2014 - Volume 35 - Issue 3 - p 261–268
doi: 10.1097/BCR.0b013e31829b0037
Original Articles

Alkali burns are known to possess high pathological potential because of their inherent ability to lyse cell membranes and penetrate intraocular structures with devastating results. The authors aimed to evaluate the most common cause of this presentation, the current treatment approaches to injury, and eventual outcome as related to severity. The authors performed a retrospective review of all patients who sustained chemical-related ocular injuries seen at the Concord Hospital Burns Unit, Australia between January 2005 and March 2012. Management was based on cooperation between ophthalmic staff and the burns unit, with emphasis on early aggressive intervention and rigorous follow-up. The records of 39 patients who presented with chemical-related injury were assessed, 12 of whom had confirmed alkali burns involving the cornea. The most commonly implicated agent was sodium hydroxide, usually in the context of otherwise trivial domestic accidents. Acute medical management included copious irrigation and the use of analgesics, cycloplegics, and topical antibiotics. In half the cases, steroid drops and oral vitamin C were also used. Ten of the 12 patients (83%) had return to premorbid visual acuity. Complications included cicatrical ectropion (n = 1), pseudoexfoliative syndrome (n = 1), and symblepharon (n = 1). Surgical correction was needed in the one patient with cicatrical ectropion. This case series shows that appropriate acute management minimizes the potentially devastating sequelae of ocular alkali burns. Emphasis should be placed on prevention of domestic and workplace injuries when using alkaline products.

From the *Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Porter Eye Care, Mt. Gravatt, Queensland, Australia; and Concord Repatriation General Hospital, Concord West, New South Wales, Australia.

Address correspondence to Robert J. George, MB, ChB, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2054, Australia.

© 2014 The American Burn Association