#56. Eye burns - thermal, chemical. Radiation damage of the eyes. Principles of treatment.

Question 1

What are the CAUSES (Etiology) of THERMAL BURNS to the Eye?

Answer 1

• Flaring Flames
  a. Lighter
  b. Hot Vapours
  c. Boiling Waters
  d. Splatters of Hot Grease
  e. Hot Metal
• DUE to EYE CLOSING REFLEX -> the EYELIDS are often affected
• EXPLOSIONS / BURNS from a GUN as well as GUN POWER burn

Question 2

What are the SYMPTOMS & DIAGNOSTICS of THERMAL BURNS to the Eye?

Answer 2

• SIMILAR to CHEMICAL Burns
  a. Epiphora
  b. Blepharospasm
  c. Pain
• APPLY Topical Anaesthetic, THEN Examine!
• IMMEDIATE OPACIFICATION of Cornea = DUE to SCALING of Epithelium AND Tissue Necrosis
• COOLED Metal Particles EMBEDDED in Cornea = DUE to BURNS from METAL SPLINTERS

Question 3

What is the TREATMENT for THERMAL BURNS to the Eye?

Answer 3

1) APPLY Cooling, ANTISEPTIC BANDAGES to RELIEVE Pain

2) REMOVE the Necrotic Areas, UNDER ANAESTHESIA

3) REMOVE Foreign Particles by brushing

4) Antibiotics

Question 4

What is the PROGNOSIS for THERMAL BURNS to the Eye?

Answer 4

LESS Severe &laquo_space;THAN Chemical Injuries

CAUSE Superficial COAGULATION

HEALS WELL with CORRECT Treatment AND Antibiotic Ointment

Question 5

What are the CAUSES (Etiology) of CHEMICAL BURNS to the Eye?

Answer 5

• Acids / Alkalines / Detergents / Solvents / Adhesives / Irritants
• Acids BURN LESS &laquo_space;than ALKALINES

0 Acids = CAUSE IMMEDIATE Coagulation Necrosis in the SUPERIFICIAL Tissues

0 Alkalines
- PENETRATION via HYDROLYSING Structural Proteins (LIQUEFACTIVE Necrosis)
- ALKALISE Aqueous Humour

Question 6

What are the SYMPTOMS of CHEMICAL BURNS to the Eye?

Answer 6

• Epiphora
• Blepharospasm
• Severe Pain

ACID Burns = IMMEDIATE LOSS of Visual Acuity

ALKALINE Burns = LOSS of Visual Acuity, SEVERAL DAYS LATER

Question 7

What is the TREATMENT for CHEMICAL BURNS to the Eye?

Answer 7

1) FIRST AID at AOD
- RESTRAIN Blepharospasm by HOLDING Eyelids OPEN

• IRRIGATE the eyes + REMOVE particles from CONJUNCTIVAL SAC

2) TREATMENT by Ophthalmologist
- Apply TOPICAL Anaesthetic
- REMOVE Small particles with Eyelids EVERTED
- FLUSH eye with BUFFER Solution
- SYSTEMIC PAIN THERAPY (If Required)

3) ADDITIONAL TREATMENT at Ward
- CONTINUE Irrigation
- TOPICAL Steroids
- NSAIDs
- TOPICAL Anaesthesia

4) SURGICAL TREATMENT
- Conjunctival AND Labial TRANSPLANT (Stem Cell)

• CYANOACRYLATE GLUE = ATTACH HARD Contact Lens if Cornea DOES NOT Heal
• TENON’S CAPSULOPLASTY = ELIMINATES Conjunctival + Scleral DEFECTS

Question 8

What are the CAUSES (Etiology) of RADIATION DAMAGE to the Eye?

Answer 8

• Ionising Radiation
• PENERATION DEPTH depending on Wavelength
• Tissue Damage has LATENCY Period
• Radiation Cataract / Retinopathy
• Tumour Irradiation in Eye OR Nasopharynx

Question 9

What are the SYMPTOMS & CLINICAL PICTURE of RADIATION DAMAGE to the Eye?

Answer 9

• LOSS of eyelashes, eyelid Pigmentation with BLEPHARITIS
• Dry Eye = Due to LOSS of Conjunctival Epithelium
• LOSS of Visual Acuity = Due to RADIATION CATARACT in 1 - 2 Years
• RADIATION RETINOPATHY in the form of ISCHAEMIC RETINOPATHY with = Bleeding / Cotton-Wool Spots / Vascular Occlusion

Question 10

What is the TREATMENT for RADIATION DAMAGE to the Eye?

Answer 10

• COVER EYES before Radiation Therapy of the Head / Neck
• SURGICAL TREATMENT = Radiation CATARACT
• PANRETINAL PHOTOCOAGULATION with ARGON LASER = Radiation RETINOPATHY