Ocular Burns

What is Ocular Burns?

Sudden eye burns can be a severe eye emergency. The seriousness of the injury depends on many things including – the substance causing the burn, how long the eye was exposed to it, the area of the eye affected, and which parts of the eye got damaged. Burns that are moderate to severe can cause serious health issues and might result in long-term effects on sight and overall lifestyle.

Immediate and lasting pain, significant scars changing the appearance, loss of regular function of the eye’s protecting parts, and permanent vision loss are all possible outcomes of serious burns. Loss of vision permanently can lead to higher chances of future injuries, feelings of sadness, chronic illnesses, and other major mental and social problems.

What Causes Ocular Burns?

Burns to the eye can be divided into two types: heat burns and chemical burns. Each type has its own way in which the damage happens after the injury. For heat burns, damage stops as soon as the heat source is removed or cools down. Examples of this include getting out of a house fire, or a sudden burn from a blast or fireworks. The eyelids usually take most of the heat injury due to their reflex to close and protective nature. Direct heat burns to the eye typically cause surface damage due to short contact time. Heat burns to the eye can come from hot water, cooking oil, curling irons, or by flames from an explosion or fire.

On the other hand, chemical burns need more urgent initial treatment. The damage may continue and affect deeper parts of the eye as long as the chemical stays in contact. This is why chemical eye injuries need treatment to clear away the harmful substance and prevent further eye damage. Chemical burns can happen from everyday items like drain or oven cleaner, laundry or dish soap, bleach, and ammonia. There’s also risk of getting them at workplaces with substances like fertilizers, industrial acid, lye, lime, or cement. Fireworks and blasts can cause both chemical and heat eye injuries. When such blasts occur, they could mean that the whole eye and possibly inside the eye has been hurt or has foreign bodies in it.

Risk Factors and Frequency for Ocular Burns

We don’t really know how many eye burns happen globally. The World Health Organization does record eye injuries that result in blindness, but they don’t keep track of eye burns. Some data from the United States has provided a bit of insight into how big this problem is. Eye burns account for anywhere from 11.5 to 22.1% of all eye injuries. In 1999, about 280,000 work-related eye injuries were treated in American emergency rooms, with eye burns being the second most common injury after foreign objects in the eye. Workers who are 20 to 34 years old are at the highest risk for eye injuries.

From 2010 to 2013, around 144,419 cases of chemical eye burns were treated in American emergency rooms. Most of these cases were people around 32 years old. But surprisingly, kids between 1 to 2 years old also had high rates of eye burns. These numbers are mostly based on case studies, and there’s a good amount of data missing, which highlights the need for more research.

• Eye injuries due to chemical burns are more likely to be caused by alkali substances (53.6%) than by acids (46.4%).
• Some sources even say that alkali burns could be twice as common as acid burns.
• The most common cause of alkali burns is ammonia-containing compounds.
• The most common cause of acid burns is sulfuric acid.

Signs and Symptoms of Ocular Burns

When a person might have come into contact with harmful chemicals, there are some key steps to follow. Firstly, healthcare providers need to ensure the individual is not in immediate danger, this includes checking that their airway is clear, their breathing is normal, and their blood circulation is good. This initial assessment in both the field and at the hospital is very important for the patient’s wellbeing while also keeping the care providers safe.

Once it’s confirmed that the person is stable and conscious, the healthcare team can start to figure out what kind of chemical they might have been exposed to. As the patient is being decontaminated, the care team should ask questions about the patient’s medical history, including any medications they are taking, allergies, or surgeries they’ve had in the past. It’s also important to understand when they last ate.

During all of this, the focus should also be on treating the patient’s eyes, since harmful chemicals can often cause damage to this sensitive area. This usually involves rinsing the eyes out with a saline solution until the pH reaches a neutral level, and then evaluating the level of damage.

The healthcare provider may need to use an anesthetic eye drop before they can properly examine the eyes. When they are examining the eyes, they will look for any cloudiness in the cornea, any changes to the color of the whites of the eyes, and the total surface area that’s been affected. To help with this examination, they might use a dye that can highlight any damaged areas. While doing this, they will be on the lookout for any signs that the chemical has caused a tear in the eye, but if they don’t see any, they can measure the pressure inside the eye as well.

• Initial assessment of airway, breathing, and circulation
• Checking mental status of the patient
• Identifying the harmful chemical
• Decontamination
• Gathering details about the patient’s medical history, medications, and allergies
• Ocular irrigation (rinsing the eyes)
• Assessing the damage to the eyes
• Checking the pressure inside the eye

Helpful resources like Safety Data Sheets (SDS) and the Poison Control Center can provide more information on how to manage such emergencies.

Testing for Ocular Burns

Usually, there’s no need for image tests like x-rays or scans when dealing with eye burns. However, if something might be lodged in the eye, like debris from an explosion, then a type of scan called a computed tomography (CT) could be useful. It scans specifically the eye socket area. If other injuries are suspected based on your symptoms and the doctor’s examination, more tests might be necessary.

Treatment Options for Ocular Burns

If you get a chemical burn in your eye, the first thing to do is thoroughly clean the eye and surrounding area (also known as the adnexa). If the rest of your body is also affected, it should be cleaned as well. Extra attention should be paid to the mouth and throats to avoid damage from inhaling the chemical. You may also need to throw away any clothes that were contaminated with the chemical. During this cleaning process, it’s important for those helping you to avoid getting the chemical on them.

If you have a special cleaning solution meant for the eyes, you can use that to wash out your eye. However, in many cases, the only option available might be tap water, and that’s okay to use too. While tap water could cause some swelling in the cornea (the clear front surface of your eye), it is still suitable to use in this emergency situation. It’s important to know that the most crucial part of this initial treatment is starting the cleaning process as quickly as possible.

Once you get to the hospital, doctors will continue washing your eye until the surface of your eye is back to its normal pH level (this is a measure of how acidic or basic something is). Depending on the severity of your injury, this process could require up to 10 liters of water and might take from 30 minutes to 4 hours. The cleaning solution most commonly used in hospitals is lactated Ringers, but normal saline or salt solution could be used as well. To make the process more comfortable, a topical anesthetic (a numbing medication) could be applied. During this cleaning process, it is also important to remove every last bit of the chemical from your eye to avoid prolonged inflammation.

In situations where a child or uncooperative adult has a chemical burn in their eye from lime, doctors might need to use anesthesia (a medication that puts you to sleep) to complete the examination and cleaning process. In severe cases of eyelid burns, a special cut, called an escharotomy, might need to be made to allow the eyelids to close and avoid further complications.

After the initial cleaning, the next steps of treatment depend on the severity of the burn and focus on controlling inflammation and promoting healing. For minor injuries, applying a topical antibiotic ointment and artificial tears can be helpful. For more severe injuries, doctors will continue monitoring for complications like exposure of the eye surface due to scarring, corneal thinning, or high pressure inside the eye. Topical steroids (medication to reduce inflammation) could be used along with a medication to reduce pain. Pain medication can be given both topically (applied directly to the eye) or systematically (taken by mouth or through injection). Eye doctors might prescribe a medication called doxycycline and vitamin C to aid in the healing process.

For those with more severe burns, more specialized treatments options are available. Eye drops made from your own blood (autologous serum) or platelet-rich plasma drops could be used. Bandage contact lenses can help heal the cornea and reduce pain. If using a bandage contact lens, an antibiotic to prevent infections from a common bacterium called Pseudomonas will also be included in the treatment. In the worst cases, a transplant of the amniotic membrane (a layer in the placenta, which is part of pregnancy) or Tenonplasty (a surgical procedure) could be necessary during the first week.

In the later phase of treatment (beyond 21 days), the focus shifts towards controlling inflammation and rehabilitation and rebuilding the surface of the eye. Depending on the severity of the corneal scarring, different types of corneal transplant can be performed to restore sight. In some cases, reconstruction of the eyelids and surrounding area might be required to prevent ongoing exposure of the eye and improve cosmetics.

What else can Ocular Burns be?

If your eye is red and painful, there could be several causes. A doctor will need to determine what exactly is wrong by taking a detailed history and examining your eye. Some possible reasons for these symptoms include:

• A foreign object inside your eye
• A ruptured or injured globe (the eye itself)
• A cut on the cornea (the clear front surface of your eye) or sclera (the white part of your eye)
• A scratch on the cornea
• Infection of the cornea or conjunctiva (the thin, clear tissue covering the front of the eye and the inside of the eyelids)
• Uveitis, which is inflammation inside the eye
• A foreign object on the surface of the eye

Your doctor will be able to distinguish whether a chemical injury or one of the above issues is causing your eye discomfort.

What to expect with Ocular Burns

There are two systems used to predict the outcome in burn victims based on early assessment and particular aspects of the burn. The Roper-Hall tool utilizes the clarity of the cornea (the eye’s clear front surface) and the amount of limbal ischemia (restricted blood flow in the limbus, which is the border part of the eye) to give a grade from I-IV. On the other hand, the Dua’s system uses the area of limbus involved and the percentage of the conjunctiva (clear tissue covering the white part of the eye) involved, to provide a grade from I to VI.

These systems grade higher numbers as indicating poorer prognoses. The Roper-Hall Classification came into use in 1965, while Dua’s classification was introduced in 2001.

Although medical science has improved since these grading systems were created, they remain useful for evaluating the severity of the injury and predicting outcomes. A foggy cornea, significant limbal ischemia, and increased conjunctival involvement suggest a less positive outcome. The extent of limbal ischemia may be difficult to determine immediately after injury and can only be reliably judged by frequent examination.

Increased limbal ischemia raises the risk of conjunctivalization, where the cornea becomes covered by tissue more like the conjunctival tissue, causing the cornea to become cloudy. This development can impair vision.

Possible Complications When Diagnosed with Ocular Burns

• Infection in the cornea (Infectious keratitis)
• Elevated pressure in the eye, which can damage the optic nerve (Glaucoma)
• Breakdown and possible hole in the cornea (Corneal/stromal melting and perforation)
• Loss of vision that cannot be restored (Permanent vision loss)
• Long-lasting inflammation and pain in the eye (Chronic inflammation and pain)
• An eye condition where one eye becomes inflamed in response to an injury in the other eye (Sympathetic ophthalmia)
• Lower than normal pressure within the eye (Hypotony)
• Clouding of the eye’s natural lens (Cataracts)

Preventing Ocular Burns

Preventing accidents at home, particularly involving harmful chemicals and young children, is extremely important. This is often achieved by making the home childproof, that is, safe for kids. Health professionals, such as doctors and nurses, play a crucial part in educating parents about the steps they can take to stop these kinds of accidents from happening.

Preventing injuries at work, on the other hand, involves different strategies. It’s important that workers wear the right protective clothing and gear when dealing with chemicals. Also, they should know the nature of the chemicals they’re handling. There are rules that require every workplace to have facilities ready for quick cleanup or “decontamination” in case someone is exposed to dangerous substances. Workers should know where to find these facilities and how to use them appropriately if needed.

Furthermore, employers should provide training to their staff about handling hazardous materials and methods for decontamination. This is especially crucial in places where there’s a chance of coming across dangerous chemical exposures.