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- Ocular chemical injuries and their management.
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Klin Monbl Augenheilkd ;A Epidemiology of industrial burns in Brisbane. Burns Incl Therm Inj ; Pfister RR. The effects of chemical injury on the ocular surface. Ophthalmology ; Saini JS, Sharma A. Ocular chemical burns—clinical and demographic profile. Burns ; Mackowiak PA. Brief history of antipyretic therapy.
Evolution in Chemical Injuries and Burns
Clin Infect Dis ;31 Suppl 5 :S Shazly TA. Cutan Ocul Toxicol ; Amniotic membrane transplantation: A review of current indications in the management of ophthalmic disorders.
Indian J Ophthalmol ; Amniotic membrane inlay and overlay grafting for corneal epithelial defects and stromal ulcers. In experimental burns, tetracycline reduced the collagenase activity and increased corneal ulcerations.
Long-term outcomes with Boston type I keratoprosthesis in ocular burns
This action is independent of the antimicrobial property and is caused by chelation of the zinc indispensable to the activity of the metalloproteinases. Cycloplegic eye drops reduce the pain and limit the formation of posterior synechia and are prescribed systematically.
Some drugs increase the chances of healing. Burns of the conjunctiva are associated with a reduction in the number of mucosal cells. The regular use of artificial tears with no preservatives is recommended. Ascorbate ascorbic acid is a co-factor of collagen synthesis, but in the case of burns its concentration in the aqueous humour is reduced.
Pfister and Paterson 23 showed that a supplementation of ascorbic acid administered locally or parenterally prevented retinal thinning and the incidence of corneal ulcerations, both experimentally and clinically. Infections are prevented by the administration of an antibiotic eye drop with a large spectrum as well as parenteral tetracycline. Analgesics are easily prescribed by oral or parenteral administration because corneal nerve lesions can be associated with intense pains.
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As with local corticotherapy, the aim of excision is to reduce the inflammatory reaction created by degradation products of the necrotic conjunctiva that participate in the detersion of the site. Excision consists of the ablation of necrotic tissues of the ocular globe surface.
To re-establish limbal circulation and to avoid the evolution towards necrosis or aseptic ulceration, a tenoplasty can be performed. This consists of the realisation of a Tenon advancement strip positioned along the limbus.
Proposed by Schermer and developed by Tseng, the LSC theory is the basis on which limbus transplant was developed. Limbal autotransplant is the technique of choice for the treatment of corneal limbal destruction and its complications. The complete conjunctival pannus that covers the cornea is removed beyond the limbus by about 3 mm. The graft is removed through a cornea incision located 1 mm forward of the limbus. The dissection realises a tunnelling of about 2 mm behind the limbus. Most authors believe it is better to wait several months to allow diminution of inflammatory reaction.
Nevertheless, some recommend to intervention early on, that is before the appearance of complications linked to the LSC deficit. Limbal allotransplant is recommended for widespread limbal lesions that are bilateral or unilateral on only one eye. The amniotic membrane is a tissue located at the interface between the placenta and the amniotic liquid was first used for ocular burn by Sorsby and Simmonds in The amniotic membrane facilitates re-epithelialisation by decreasing the inflammatory and cicatricial reaction.
The amniotic membrane is covered by the corneal epithelium, integrated with the stroma and then resorbed. The current practice is to realise the amniotic membrane transplant rapidly, during the early phase of the burn. Good results are also observed when it is performed later on. It must be performed with a limbal transplantation. TK can be realised at the same time as a limbal allotransplant. Nevertheless, epithelial scarring and the corneal transparency are better when the TK is realised later on between one and 13 months.
Keratoprosthesis remains the ultimate surgical resource for bilateral corneal blindness, when TK and LSC treatments are no longer realisable. Although harder to perform, the results of keratoprosthesis are sometimes very encouraging. Nevertheless, it remains indicated for conjunctival fornix reconstruction corrected by cicatricial fibrosis. Chemical burns can be responsible for severe, bilateral and irreversible alteration to the visual function.
The initial clinical examination is sometimes hard to perform because of the severe symptomatology. Nevertheless, it allows classification of the lesions, establishes a prognosis and most importantly, guides the therapeutic care. Prognosis for the worst ocular burns has improved during the past decade thanks to a better knowledge of the corneal epithelium physiology.
Surgical techniques to restore LSCs that were destroyed have changed the prognostics of severe corneal burns. Above all, prevention is essential to decrease the incidence of burns, especially in the industrial world, since a large number of dramatic cases could have been avoided with a minimum of information, training and regulation. Its content should not be considered medical advice, diagnosis or treatment recommendations. Submit to journal. Subscribe User Login. Filter Specialty Register Login.paysenwardcontres.cf
Evolution in Chemical Injuries and Burns
Filter specialty. Submit To The Journals. Severe Ocular Burns The worst ocular lesions are chemical burns caused by strong bases and acids. Get access to premium content Subscribe today. Previous Article Next Article Abstract The worst ocular lesions are chemical burns caused by strong bases and acids.
Keywords Ocular burns, chemical burns, ocular lavage, ocular irrigation, ocular surface, limbal transplant, amniotic membrane transplant Disclosure The authors have no conflicts of interests to declare. Epidemiology Chemical burns are more common and caused by strong bases or acids. Treatment There are two aspects to the goal of therapeutic care of severe ocular burns.
Ocular Lavage Ocular lavage is a crucial procedure. Medical Treatment The use of local corticoids, 17 long-debated, can be justified by their ability to reduce the inflammatory reaction. Surgical Treatment As with local corticotherapy, the aim of excision is to reduce the inflammatory reaction created by degradation products of the necrotic conjunctiva that participate in the detersion of the site.
Conclusion Chemical burns can be responsible for severe, bilateral and irreversible alteration to the visual function. Related Articles Cornea. Advances in Dry Eye Disease. Anterior Segment. Dry Eye Disease and Cataract Surgery. Evolving Therapies for Fuchs Endothelial Dystrophy. Latest Developments in Corneal Surgery. In Partnership. Submit to the Journals. Other websites from.