Pathology of eye burns

2021-02-02 12:00 AM

Eye burns are a special emergency in ophthalmology. In many cases, the damage is very severe, even though urgent treatment does not prevent blindness.

According to statistics of the Central Hospital Trauma Department in recent years, eye burns are more common in men (85%), commonly in working ages from 18-55 years old (accounting for 49%), children and school. birth also accounts for a considerable proportion of 30%. 78% of whom are people living in rural areas.

Burning agent

There are several types of factors that can cause eye damage:

Hot burns

Burns caused by fire, shot in the eyes of molten iron or by boiling water, hot fried grease ...

Burns caused by radiation

Radiation rays can cause severe eye burns, especially ionizing radiation such as g- rays, X-rays, or energetic rays such as lasers. Ultraviolet rays can also because eye burns but are usually not serious. Infrared rays do not burn eyes, but if exposed for a long time, they will cause cataracts.

Chemical burns

Chemical is the most common burning agent and also the most severe burn agent. Burners can be acids such as sulfuric acid H2SO4, hydrochloric acid HCl or bases such as NaOH caustic soda, Ca (OH) 2 lime. In addition, some organic solvents can also because severe eye burns such as benzene C6H6, ethylic alcohol C2H5OH, acetone ...

clinical

Hot burns

When a hot agent such as fire, smoke, boiling water, fried oil ... hits the eye, the eyelids will immediately close to protect the eyeball, so eye burns are usually mild. A systematic examination is needed to assess the degree of systemic burn. Systemic treatment is essential, eye treatment is just a combination. Eye application of antibiotics and other drugs that enhance nutrition.

Eye burns caused by radiation

There are many different clinical scenes.

Eye burns caused by ionizing radiation

Eye burns caused by g- rays or X-rays may occur in patients receiving radiation treatment to tumors of the jaw area, in victims of nuclear explosions or radiation leaks from power plant reactors. atom.

Eye damage is usually very severe. The dry cornea is caused by the cells that grow and regenerate the cornea and are destroyed by radiation. Then there is superinfection damage causing corneal perforation necrosis leading to intraocular infection. Often the eyeballs have to be removed.

Eye burns caused by laser beams

Today lasers are widely used in industrial production, in the military and in medicine. The essence of the laser is a light Amplification by Stimulated Emission of Radiation (Light Amplification by Stimulated Emission of Radiation), which is capable of penetrating transparent media and non-pigmented tissues. Upon reaching the retinal pigment epithelium of the retina the laser beam is absorbed, the light energy (photovoltaic) is converted to heat energy that causes burns, which thickens proteins in cells and kills cells. The fibrous cells then grow to replace the scar tissue. Thus, the laser causes irreversible burns of the retina.

When we look at the sun for a long time, during solar eclipses, the eyes absorb a large number of energetic rays and as a result, the patient sees dark, teary eyes, retinal examination. thickening of the central retina. Ultimately, scarring damage leads to a central focus in the market.

Eye burns caused by ultraviolet rays (ultraviolet rays)

Ultraviolet rays are abundant in beaches, on snowy mountains, from arc light and even from some lamps used for stage lighting.

After being exposed to a large number of ultraviolet rays for 2 - 6 hours, patients experience severe pain in the eyes, heavy tears, dazzling feeling, fear of light, unable to open the eyes. Examination found that eyelids were twitching, corneal lesions were shallow, fluorescein was dense, but there were no lesions of the fundus.

Treatment with surface anesthetic for 5 minutes / 1 time until the patient opens natural eyes. Then, tightly close your eyes with antibiotic ointment to rest your eyes, avoid mechanical contact. The corneal epithelium will completely regenerate after 24 hours.

Chemical burns

The clinical picture of eye burns due to chemicals is very diverse, depending on the concentration of the burning chemical, the time it is taken to the hospital and the level of first aid treatment at the scene.

Eye burns due to acid are common in battery and metal plating facilities, sometimes due to being intentionally injected with acid into the eyes by others. Burns caused by caustic soda are common in establishments that produce aluminum and soap making. Burns caused by lime are common in daily life or construction. Burns caused by benzene can be found in rubber manufacturing facilities. All of these chemicals can cause burns in laboratory accidents.

Mechanical symptoms

Immediately after the accident the patient felt a sharp pain or a burning pain in his eyes. At the same time, his eyes were completely blurred, unable to recognize relatives and surroundings. Common signs of accompanying tears are watery eyes, dazzling light, and unable to open your eyes.

The general state often provokes anxiety, panic, and pain.

Physical symptoms

Need an eye exam very urgently. The eye exam will be meticulously, fully assessing damage after first aid, chemicals in the eye have been eliminated.

Eyelids

If the eye burns due to the concentrated acid of the eyelids are often very badly damaged, the skin of the necrotic lashes can sometimes be deep necrosis of the entire thickness of the eyelids. If the eye burns due to moderate acidity or alkali or from chemicals other than the eyelids, the damage will be less. Blistering or redness of the skin of the eyelashes. Even lighter, only the skin of the eyelashes turns pale.

Eyelash curl is a common sign of corneal damage attached.

Conjunctiva

There are lesions of varying degrees:

Mild damage to the conjunctiva: congested erectile conjunctiva, red eye color.

Moderate damage to the conjunctiva: the conjunctiva is moderately edematous, rarely the edema rises out of the eyelid.

Severe damage to the conjunctiva: conjunctival edema and hemorrhage. Hemorrhage indicates anemia of the conjunctiva due to embolism or damage to the vessel wall, when the conjunctiva has many new vessels.

Severe damage to the conjunctiva is particularly severe: the conjunctiva is necrotic. Using a needle or pulling at the conjunctiva is painless and bleeding, signs of Ambler.

Corneal

Burn lesions on the cornea also have four degrees as on the conjunctiva:

Minor damage: shallow lesions in the epithelium, the cornea stains scattered fluorescein.

Moderate injury: just superficial, but more extensive than above. Epithelium slips into a wide cluster that catches fluorescein color. When the epithelium is completely removed, if not examined carefully, it may be mistaken for a negative fluorescein test.

Severe damage: the damage has deepened to the parenchyma. The cornea is opaque, the Descemet membrane expands to form folds.

The damage is particularly severe: the cornea is opaque as white as porcelain, unable to see the anterior chamber and iris.

Progression and complications

Evolution

Progresses depending on the type of agent that causes the burn. Acid is a substance with high oxidizing properties, strong corrosive ability, so the damage is often very wide, but the acid has the property of protein coagulation, creating a protective wall that prevents chemicals from penetrating deeply creating dark damage multi right from the start. With bases, on the other hand, the corrosive ability of bases is not high, so there are places where the base material cannot destroy the epidermis, so it does not cause burns to the eyelids. acid. But once in the eye the base material will easily break down the epithelium of the conjunctiva and cornea because this layer is not as strong as the epidermis of the eyelid. Then the base material continues to seep through the cornea, causing damage in the anterior chamber, vitreous body, vitreous and retina. This damage that continues to happen in the next few days is difficult to predict.

Minor vision burns can be completely or almost completely reversible. Severe burns recover slower and worse, leaving many complications and sequelae.

Complications of eye burns

Perforation of the cornea: corrosive chemicals.

Uveitis: common after alkaline burns.

Secondary glaucoma: difficult to treat because the scalded conjunctiva cannot create a cyst scarring after fistula surgery.

Cataracts: Cataract surgery when the eye is completely calm and if prognosis improves vision.

Sequelae of eye burns

Eye burns leave many complications that are complicated, sometimes irreversible:

Eyelids: scarring, pulling, causing eyelashes, entanglement, loose hair, requiring surgery

Moral: rule of law.

Eyelid adhesions: Fibrous globules form that binds the eyeball conjunctiva to the ciliary conjunctiva, making both the eyelids and eyeballs inactive.

Corneal scarring: reduced or lost vision. Can a corneal transplant later if conditions permit?

Corneal new vessels: peripheral blood vessels and fibrous and epithelial cells of the conjunctiva enter the cornea, making the cornea opaque and deformed.

Dry eyes: due to damage to the tear glands.

Eyeball atrophy: is the ultimate consequence. If the eyeballs have been atrophying but still irritated and painful, then it is necessary to remove the eye.

Classification of eye burns

According to the agent causing burns

Heat burn.

Burns caused by radiation.

Chemical burns.

According to the degree of damage to the corneal conjunctiva

Grade 1, mild: Conjunctivitis, corneal epithelial damage, superficial. This level occurs after accidents caused by dilute chemicals. Common in daily activities due to vinegar, chili, lemon or soap in the eyes.

Grade 2, moderate: conjunctival edema, corneal epithelial eruption. This level often occurs after agricultural accidents caused by sap, pesticides or the venom of some insects or reptiles ... shot in the eye.

Grade 3, severity: conjunctival edema and hemorrhage, corneal edema. This level is common in construction due to hardened lime and chemical-based industrial production.

Grade 4, particularly severe: necrotic conjunctiva, opaque porcelain cornea. Burns of this degree are usually caused by un-hardened lime, thick caustic soda or acid splash.

Treat eye burns

General principles

The basic rule of thumb when managing an eye burn emergency is to remove the burning agent from the eye immediately. Only then do other treatments.

Treatment of first aid

Flush eyes with plenty of water and prolong with any source of clean water available at the scene to reduce the concentration of the burn agent. Eye wash time should last a minimum of 15 minutes per eye. Particularly for eye burns caused by lime need to check and remove all lumps in the eye if any before washing eyes.

Absolutely avoid

Use polluted water sources to wash eyes as this will cause eye infections leading to corneal perforation.

Use acids to neutralize the base and vice versa: doing so will burn the mixture, allowing the chemical to expand and penetrate deeper.

After washing the eyes, if possible, give the patient antibiotics and pain relief, then quickly transfer the patient to a medical facility with an eye specialist.

Treatment at ophthalmology

Eye pH should be measured immediately. If the pH is not neutral, continue to wash the eyes with isotonic solution until pH = 7. If the lesions have penetrated deeply, the eyes can be washed continuously by dripping into the eyes through the transmission line system. At the same time must proceed to wash away the rule to avoid inflammation later on.

Antibiotics have a wide spectrum of antibiotic eye, preferably using ointments to limit eyeball stickiness. Use systemic antibiotics for severe burns.

Apply Atropine to prevent contact with the iris from the front of the lens. Day 2 times, 1 drop each time. Pay attention to cover the hole to avoid oral medicine causing poisoning in children.

Eyelid adhesive room: apply antibiotic ointment to the same top and bottom items, day several times a day or place a non-stick mold on the 2-3 day after burn.

Enhance corneal nutrition: eye products with vitamins group A, B, C or inject serum itself under the conjunctiva. Increase your diet rich in protein and vitamins. Drink plenty of water to eliminate toxins.

Use local and systemic sedatives and pain relievers. Apply psychotherapy, comfort patients.

Emergency surgery

Emergency surgery is indicated for very severe burns, eye wash cannot eliminate all burn chemicals.

Room money laundering

Usually applied to alkaline burns in order to get rid of the burning substances that have seeped into the anterior chamber to prevent them from penetrating further.

Passow-Poliak surgery

When the conjunctiva is much edema due to the chemical seeping in and then depositing under the conjunctiva, it is necessary to incision the spokes in the four quadrants between the orthogonal muscles so that the toxins under the conjunctiva can escape.

Doenig surgery

Indicated when severe necrotic conjunctiva is no longer reversible.

After removing all part of the necrotic conjunctiva, take the lip mucosa or placenta and patch it into the removed conjunctiva.

Treatment of complications and sequelae of eye burns

Symptoms

Glaucoma: corneal scavenging surgery should coordinate with anti-metabolic drug pressure. If not, the lumen photolysis can be done with diode laser at 810 nm.

Glass Chisel: Take out the outer vitreous body and install the artificial glass body if conditions permit.

Perforation of the cornea: conjunctival stitching or corneal transplant. If the eye loses function, surgery may be required to remove the eye.

Uveitis: corticosteroid and atropine use.

Sequelae

Lashes: Sapecko surgery, lip mucosa and eyelids patching.

Eyelid stickiness: separating the eyeball, the placenta patch or the lip lining patch.

Rule of law: routine connection of the nose, Dupuy-Dutemps surgery

Corneal scarring: corneal transplant if conditions permit.

Dry eyes: long-term artificial tears

Prevention

Educate about eye burn prevention awareness for all, especially at the age of students and workers. Propaganda about burn causes, how to protect yourself and everyone, how to deal with an accident ...

Improve working conditions and increase labor protection for workers and farmers.

Must handle and give first aid properly and promptly, then refer to the eye specialist.