MDT EYE Burns (Flash and Chemical)

Question 1

Ultraviolet burns of the cornea are usually caused by what?

Answer 1

-use of a sunlamp without eye protection
-exposure to a welding arc
-or exposure to the sun when skiing
(“snow blindness”)

Question 2

Your patient has some or all of these issues what would you suspect?

(a) Symptoms
1) Moderate-to-severe ocular pain, foreign body sensation, red eye, tearing, photophobia, blurred vision; often a history of welding or using a sunlamp without adequate protective eyewear.
2) Symptoms typically worsen 6 to 12 hours after the exposure. Usually bilateral.

(b) Signs
1) Critical: Numerous, punctate lesions or microdots on the corneal surface (after staining and under high magnification using the cobalt-blue light).
2) Other: Conjunctival injection, eyelid edema, corneal edema, miotic pupils that react sluggishly, and mild anterior chamber reaction.

Answer 2

Flash Burns (Ultraviolet Keratopathy)

Question 3

What are some DDx for Flash burn?

Answer 3

(a) Toxic epithelial keratopathy (chemical)
(b) Thermal burn/keratopathy (boiling fluid, flame)
(c) Ocular foreign body
(d) Corneal abrasion

Question 4

What Labs/Studies would you do for Flash burn?

Answer 4

(a) History (Welding, Sunlamp)

(b) Slit lamp examination: Use fluorescein stain. Evert the eyelids to search for a foreign body.

Question 5

Your patient has some or all of these issues what would meds would you treat with?

(a) Symptoms
1) Moderate-to-severe ocular pain, foreign body sensation, red eye, tearing, photophobia, blurred vision; often a history of welding or using a sunlamp without adequate protective eyewear.
2) Symptoms typically worsen 6 to 12 hours after the exposure. Usually bilateral.

(b) Signs
1) Critical: Numerous, punctate lesions or microdots on the corneal surface (after staining and under high magnification using the cobalt-blue light).
2) Other: Conjunctival injection, eyelid edema, corneal edema, miotic pupils that react sluggishly, and mild anterior chamber reaction.

Answer 5

Pain treatment
Oxycodone 5mg Q 4-6 hours PRN severe pain

Antibiotic ointment: 4 to 8 times’ QD
(erythromycin or Trimethoprim/polymyxin B)

Consider a pressure patch for the more affected eye for 24 hours in reliable patients

Question 6

Initial Care and Follow Up of Flash burns?

Answer 6

(a) All patients recover within 24–48 hours without complications.
(b) If a bandage soft contact lens was placed, the patient is seen in 1 to 2 days.

Question 7

True/False
FLASH BURNS
Consider mild oral opioids for adequate pain relief as pain can be severe

Answer 7

True

Question 8

True/False
FLASH BURN
Corneal epithelial healing will be faster if local anesthetic is prescribed

Answer 8

FALSE

Delay of corneal epithelial healing if local anesthetic is prescribed