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CHEMICAL EYE INJURIES

CHEMICAL EYE INJURIES. G. PAPANIKOLAOU. EPIDEMIOLOGY. 2/3 at work, young, males Alkali:acid=2:1 Alkali: NH3, NaOH, Ca(OH)2, KOH, MgOH2 Acid: H2SO4, HF, Acetic, HCl. Damage depends on: pH area Volume/duration Inherent toxicity. PATHOPHYSIOLOGY. Direct effect

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CHEMICAL EYE INJURIES

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  1. CHEMICAL EYE INJURIES G. PAPANIKOLAOU

  2. EPIDEMIOLOGY 2/3 at work, young, males Alkali:acid=2:1 Alkali: NH3, NaOH, Ca(OH)2, KOH, MgOH2 Acid: H2SO4, HF, Acetic, HCl • Damage depends on: • pH • area • Volume/duration • Inherent toxicity

  3. PATHOPHYSIOLOGY • Direct effect • Indirect effect (inflammation)

  4. PATHOPHYSIOLOGY II • POINTS IN CORNEAL HEALING: • Epithelium regulates keratocytes, prevents sterile ulceration • TGF-beta 2: inhibits collagenase synthesis by keratocytes • Limbal vessels: provide collagenase inhibitors • Stem cells: centripetal healing • ‘Transdifferentiation’/ ‘conjuctivalization’ • Stroma: type I collagen (keratocytes) • Steroids intervene with keratocyte migration/ synthesis • Ascorbate co- factor in collagen synthesis • MMPs: increase after 10th day • PMN: 12-24h and 14-21days

  5. PATHOPHYSIOLOGY III • PHASES: • Immediate • Acute (0-7) • Early repair (7-21) • Late repair (>21)

  6. GRADING • Corneal clarity • Limbal ischaemia

  7. ACUTE MANAGEMENT EMERGENCY !!! • AIMS • Remove offending agent/ stop further damage • Reduce inflammation • Control IOP • Reduce matrix degradation • Promote reepithelization

  8. MANAGEMENT I • Irrigation • Eversion of lids • Debridement • A/C Paracentesis Grade I and II: steroid, antibiotic, cycloplegia for 1/52.

  9. TIPS • Recheck pH 5-10 min after irrigation • White eye worse than red • Complete epith defects or if only Bowman’s delay in taking up FLN: Repeat • Avoid PHNL

  10. MANAGEMENT II • Steroids/ up to10/7, NSAIDS • Antibiotics • Vit-C/ early • Citric acid/ Ca chelation/ early • Tetracyclines/ chelate zinc • Acetylcysteine/ MMP • Artificial tears • BCL • Tarsoraphy • IOP control

  11. MANAGEMENT III • Tenoplasty/ early in grade IV (limb. Vascularity) • Stem cell transplant (auto/allo)/ early or late • Amniotic membrane graft • Conjuctival/ mucosal grafts • Correct lid malposition • Fornix reconstruction • Dry eye • Glaucoma, Cataract • Cyanoacrylate glue, tectonic PTK • PTK (large), Keratoprosthesis

  12. COMPLICATIONS • Non-healing epith defect/ conjuctivalization/ melting (stem) • Corneal opacities • Cataract • Glaucoma/ phthisis • Dry eye • Lid malposition/ symblepharon/ trichiasis: more scarring

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