Theoretical and clinical explanation of ocular injuries in a simple way

1. OCULAR INJURIES
BY
Dr. LUCKY NARAIN (MS)

2. Damage or trauma in
fl
icted to the eye by external means. The concept includes both surface injuries and
intraocular injuries. During trauma so
ft
ti
ssues and bony structures around the eye maybe involved.
OCULAR TRAUMA
OPEN GLOBE INJURY
Open-globe injury is associated with a full-thickness
wound of the sclera or cornea or both. It includes
rupture and lacera
ti
on of eyewall.
CLOSED GLOBE INJURY
Closed-globe injury is the one in which eyewall
(sclera and cornea) does not have a full thickness
wound but there is intraocular damage. It includes
contusion and lamellar lacera
ti
on.

3. CLOSED GLOBE INJURY
1. Contusion refers to the closed-globe injury
resul
ti
ng from blunt trauma. Damage may occur
at the site of impact or at a distant site.
2. Lamellar lacera
ti
on is a closed-globe injury
characterized by a par
ti
al thickness wound of the
eyewall caused by a sharp object or blunt trauma
OPENED GLOBE INJURY
1. Rupture refers to a full-thickness wound of eyewall
caused by the impact of blunt trauma.
2. Laceration refers to a full-thickness wound of
eyewall caused by a sharp object.
a) Penetra
ti
ng injury refers to a single lacera
ti
on of
eyewall caused by a sharp object which traverses
the coats only once.
b) Perfora
ti
ng injury refers to two full thickness
lacera
ti
ons (one entry and one exit) of the eyewall
caused by a sharp object or missile. The two
wounds must have been caused by the same agent
(earlier known as double perfora
ti
on).
c) lntraocular foreign body injury is technically
a penetra
ti
ng injury associated with retained
intraocular foreign body. However, it is grouped
separately because of di
ff
erent clinical implica
ti
ons.

4. CONTUSION
CLOSED GLOBE INJURY

5. PENETRATING INJURY PERFORATING INJURY
OPEN GLOBE INJURY

6. Extraocular foreign bodies are quite common in industrial and agricultural workers. Even in day-to day life,
these are common.
Common sites and types
Common sites A foreign body may be impacted in the conjunc
ti
va or cornea
• On the conjunc
ti
va, it may be lodged in the sulcus subtarsalis, fornices or bulbar conjunc
ti
va.
• In the cornea, it is usually embedded in the epithelium, or super
fi
cial stroma and rarely into
the deep stroma.
Common types common foreign bodies are par
ti
cles of dust, sand, steel, glass, wood and small insects.
Clinical features
Symptoms • Discomfort, profuse watering and redness in the eye.
• Pain and photophobia are more marked in corneal foreign body than the conjunc
ti
va.
• Defec
ti
ve vision occurs when it is lodged in the centre of cornea.
Signs • Blepharospasm and conjunc
ti
val conges
ti
on.
• A foreign body can be localized on the conjunc
ti
va or cornea by oblique illumina
ti
on.
• Slit-lamp examina
ti
on a
ft
er
fl
uorescein staining is the best method to discover corneal
foreign body.
• Double eversion of the upper lid is required to discover a foreign body in the superior fornix.
EXTRAOCULAR INJURIES

7. Complica
ti
ons
1. Acute bacterial conjunc
ti
vi
ti
s
2. Corneal ulcera
ti
on
3. Pigmenta
ti
on and/or opacity may be le
ft
behind
Treatment
Extraocular foreign bodies should be removed as early as possible.
1.Removal of conjunc
ti
val foreign body A foreign body lying loose in the lower fornix, sulcus
subtarsalis or in the canthi may be removed with a swab s
ti
ck or clean handkerchief even without
anaesthesia. Foreign bodies impacted in the bulbar conjunc
ti
va need to be removed with the help
of a hypodermic needle a
ft
er topical anaesthesia.
2.Removal of corneal foreign body.
I. Eye is anaesthe
ti
sed with topical ins
ti
lla
ti
on of 2 to 4% xylocaine and the pa
ti
ent is made to lie
supine on an examina
ti
on table.
II. Lids are separated with universal eye speculum, the pa
ti
ent is asked to look straight upward and light
is focused on the cornea.
III. First of all, an a
tt
empt is made to remove the foreign body with the help of a wet co
tt
on swap s
ti
ck.
If it fails then foreign body spud or hypodermic needle is used.
IV. Extra care is taken while removing a deep corneal foreign body, as it may enter the anterior chamber
during manoeuvring.
V. If such a foreign body happens to be magne
ti
c, it is removed with a hand-held magnet.

8. XYLOCAINE 4% HAND-HELD MAGNET
VI. A
ft
er removal of foreign body, patching with an
ti
bio
ti
c eye ointment is applied for 24 to 48 hours.
VII. An
ti
bio
ti
c eyedrops are ins
ti
lled 3-4
ti
mes a day for about a week.
UNIVERSAL EYE SPECULUM

9. BLUNT TRAUMA
CAUSES AND PATHOGENESIS OF DAMAGE
Modes of trauma
• Direct blow to the eyeball by
fi
st, a tennis or cricket or another ball or blunt instruments like s
ti
cks, and big
stones.
• Accidental blunt trauma to eyeball may also occur in roadside accidents, automobile accidents, injuries by
agricultural and industrial instruments/machines and fall upon the projec
ti
ng bluntobjects
Mechanics of forces of blunt trauma
Blunt trauma of eyeball produces damage by di
ff
erent forces as described below:
1. Direct impact on the globe. It produces maximum damage at the point where the blow is received.
2. Compression wave force. It is transmi
tt
ed through the
fl
uid contents in all the direc
ti
ons and strikes the
angle of anterior chamber, pushes the iris-lens posteriorly, and also strikes the re
ti
na and Choroid.
Some
ti
mes, the compression wave may be so explosive, that maximum damage may be produced at a point
distant from the actual place of impact. This is called contre- coup damage.
3. Re
fl
ected compression wave force. A
ft
er striking the outer coats, the compression waves are re
fl
ected
towards the posterior pole and may cause foveal damage.

10. DIRECT IMPACT COMPRESSION WAVE FORCE REFLECTED COMPRESSION WAVE
MECHANICS OF BLUNT TRAUMA TO EYEBALL

11. 4. Rebound compression wave force. A
ft
er striking the posterior wall of the globe, the compression waves
rebound back anteriorly. This force damages the re
ti
na and choroid by forward pull and lens iris
diaphragm by forward thrust from the back.
5. Indirect force. Ocular damage may also be caused by the indirect forces from the bony walls and elas
ti
c
contents of the orbit, when globe suddenly strikes against these structures.
REBOUND COMPRESSION WAVE FORCE

12. TRAUMATIC LESIONS OF BLUNT TRAUMA
Trauma
ti
c lesions produced by blunt trauma can be grouped as follows:
A. Closed-globe injury
B. Globe rupture
C. Extraocular lesions
A. Closed-globe injury
Either there is no corneal or scleral wound at all (contusion) or it is only of par
ti
al thickness (lamellar
lacera
ti
on). Contusional injuries may vary in severity from a simple corneal abrasion to an extensive
intraocular damage.
I. Cornea
1. Simple abrasions. These are very painful and diagnosed by
fl
uorescein staining. These usually heal up
within 24 hours with patching applied a
ft
er ins
ti
lling an
ti
bio
ti
c ointment.
2. Par
ti
al corneal tears (lamellar corneal lacera
ti
on). These may also follow a blunt trauma and are treated
by topical an
ti
bio
ti
cs and patching.
3. Acute corneal oedema may occur following trauma
ti
c dysfunc
ti
on of endothelial cells. It may be
associated with Descemet’s folds and stromal thickening. It, usually, clears up spontaneously; rarely a
deep corneal opacity may be the sequelae.

13. 4. Blood staining of cornea. It may occur occasionally from the associated hyphaema and raised
intraocular pressure. Cornea becomes reddish brown or greenish in colour and in later stages simulates
disloca
ti
on of the clear lens into the anterior chamber. It clears very slowly from the periphery towards
the centre, the whole process may take even more than two years.
BLOOD STAINING OF CORNEA

14. II. Sclera
Par
ti
al thickness scleral wounds (lamellar scleral lacera
ti
ons) may occur alone or in associa
ti
on
with other lesions of closed-globe injury.
III. Anterior chamber
1. Trauma
ti
c hyphaema (blood in the anterior chamber). It occurs due to injury to the iris or ciliary
body vessels.
HYPHAEMA

15. ■ Treatment includes:
• Conserva
ti
ve treatment is aimed at preven
ti
on of rise in IOP and occurrence of secondary haemorrhage
(re-bleed).
• Surgical treatment. A small hyphaema usually clears up with conserva
ti
ve treatment. A large non
resolving hyphaema causing raised IOP should be drained to avoid blood staining of the cornea.
2. Exudates. These may collect in the anterior chamber following trauma
ti
c uvei
ti
s.
IV. Iris, pupil and ciliary body
1. Traumatic miosis. It occurs ini
ti
ally due to irrita
ti
on of ciliary nerves. It may be associated with spasm
of accommoda
ti
on.
2. Traumatic mydriasis (Iridoplegia). It is usually permanent and may be associated with trauma
ti
c
cycloplegia.
3. Rupture of the pupillary margin is a common occurrence in closed-globe injury.

16. RUPTURE OF PUPILLARY MARGIN

17. 4. Iridodialysis, i.e., detachment of iris from its root at the ciliary body occurs frequently. It results in a
D-shaped pupil and a black biconvex area seen at the periphery.
5. An
ti
fl
exion of the iris. It refers to rota
ti
on of the detached por
ti
on of iris, in which its posterior surface
faces anteriorly. It occurs following extensive iridodialysis.
6. Retro
fl
exion of the iris. This term is used when whole of the iris is doubled back into the ciliary region
and becomes invisible.
7. Trauma
ti
c aniridia or iridemia. In this condi
ti
on, the completely torn iris (from ciliary body) sinks to the
bo
tt
om of anterior chamber in the form of a minute ball.
8. Angle recession refers to the tear between longitudinal and circular muscle
fi
bres of the ciliary body. It is
characterized by deepening of the anterior chamber and widening of the ciliary body band on
gonioscopy. Later on, it is complicated by glaucoma.
9. In
fl
ammatory changes. These include trauma
ti
c iridocycli
ti
s, haemophthalmi
ti
s, post-trauma
ti
c iris
atrophy and pigmentary changes.
Treatment. It consists of atropine, an
ti
bio
ti
cs and steroids. In the presence of ruptures of pupillary
margins and subluxa
ti
on of lens, atropine is contraindicated.

18. IRIDODIALYSIS
ANIRIDIA

19. V. Lens
1. Vossius ring. It is a circular ring of brown pigment seen on the anterior capsule. It occurs due to
striking of the contracted pupillary margin against the crystalline lens. It is always smaller than the size
of the pupil.
VOSSIOUS RING

20. 2. Concussion cataract. It occurs mainly due to imbibi
ti
on of aqueous and partly due to direct mechanical
e
ff
ects of the injury on lens
fi
bres.
• Discrete subepithelial opaci
ti
es are of most common occurrence.
• Early rose
tt
e cataract (punctate). It is the most typical form of concussion cataract. It appears as feathery
lines of opaci
ti
es along the star-shaped suture lines; usually in the posterior cortex.
• Late rose
tt
e cataract. It develops in the posterior cortex 1 to 2 years a
ft
er the injury. Its sutural extensions
are shorter and more compact than the early rose
tt
e cataract.
• Di
ff
use (total) concussion cataract. It is of frequent occurrence.
ROSETTE CATARACT

21. 3. Trauma
ti
c absorp
ti
on of the lens. It may occur some
ti
mes in young children resul
ti
ng in aphakia.
4. Subluxa
ti
on of the lens. It may occur due to par
ti
al tear of zonules. The subluxated lens is slightly
displaced but s
ti
ll present in the pupillary area. Subluxated lens may cause trembling of the iris
(iridodonesis) and/or trembling of lens (phacodonesis).
5. Disloca
ti
on of the lens. It occurs when rupture of the zonules is complete. It may be intraocular or
extraocular. Intraocular disloca
ti
on may be anterior or posterior. Extraocular disloca
ti
on may be in the
subconjunc
ti
val space.
SUBLUXATION ANTERIOR DISLOCATION POSTERIOR DISLOCATION
DISPLACEMENTS OF LENS

22. VI. Vitreous
1. Liquefac
ti
on and appearance of clouds of
fi
ne pigmentary opaci
ti
es (a most common change).
2. Detachment of the vitreous either anteriorly at the base or posterior (PVD) may occur.
3. Vitreous haemorrhage. It is of common occurrence
4. Vitreous hernia
ti
on in the anterior chamber may occur with subluxa
ti
on or disloca
ti
on of the lens.
VITREOUS HAEMORRHAGE

23. VII. Choroid
1. Rupture of the choroid. The rupture of choroid is concentric to the op
ti
c disc. Rupture may be single
or mul
ti
ple. On fundus examina
ti
on, the choroidal rupture looks like a whi
ti
sh crescent (due to
underlying sclera) with
fi
ne pigmenta
ti
on at its margins. Re
ti
nal vessels pass over it.
CHOROIDAL RUPTURE

24. 2. Choroidal haemorrhage may occur under the re
ti
na (subre
ti
nal) or may even enter the vitreous if
re
ti
na is also torn.
3. Choroidal detachment is also known to occur following blunt trauma.
CHOROIDAL HAEMRRHAGE CHOROIDAL DETACHMENT

25. VIII. Re
ti
na
1. Commo
ti
o re
ti
nae. It is of common occurrence following a blow on the eye. It manifests as a
considerable area of the posterior pole with a ‘cherry-red spot’ in the foveal region. It may
disappear a
ft
er some days or may be followed by pigmentary changes
COMMOTIO RETINAE

26. 2. Re
ti
nal haemorrhages. These are quite common following concussion trauma. Mul
ti
ple haemorrhages
including
fl
ame-shaped.
3. Re
ti
nal tears.
4. Re
ti
nal detachment.
5. Concussion changes at macula. Trauma
ti
c macular oedema is usually followed by pigmentary
degenera
ti
on. Some
ti
mes, a macular cyst is formed, which on rupture may be converted into a lamellar
or full thickness macular hole.
RETINAL HAEMORRHAGE

27. B. Globe rupture
Globe rupture is a full-thickness wound of the eyeball (sclera, cornea or both) caused by a blunt object.
Types of globe rupture
Globe rupture may occur in two ways:
1. Direct rupture may occur, though rarely, at the site of injury.
2. Indirect rupture is more common and occurs because of the compression force. The impact results in
momentary increase in the intraocular pressure and an inside-out injury at the weakest part of eyewall.
Clinical features
Rupture of the globe may be associated with: Prolapse of uveal
ti
ssue, vitreous loss, intraocular
haemorrhage and disloca
ti
on of the lens.
• Intraocular pressure may be raised ini
ti
ally, but ul
ti
mately it is decreased.
• Accompanying signs include irregular pupil, hyphaema, commo
ti
o re
ti
nae, choroidal rupture, and
re
ti
nal tears.
Treatment
• Repair of tear in the eyewall should be done under general anaesthesia to save the eyeball whenever
possible.
• Postopera
ti
ve treatment should include an
ti
bio
ti
cs, steroids and atropine.
• Enuclea
ti
on may be required in a badly damaged eye where salva
ti
on is not possible.

28. C. Extraocular lesions
1. Conjunctival lesions include:
• Subconjunctival haemorrhage occurs very commonly. It appears as a bright red spot.
• Chemosis and lacerating wounds of conjunctiva (tears) are also not uncommon
SUBCONJUNCTIVAL HAEMORRAGE

29. 2. Eyelid lesion include:
• Ecchymosis of eyelids is of frequent occurrence.
• Lacera
ti
on and avulsion of the lids.
• Trauma
ti
c ptosis may follow damage to the levator muscle.
3. Lacrimal apparatus lesions
4. Op
ti
c nerve injuries
5. Orbital injury
ECCHYMOSIS OF EYELID LACERATION AND AVULSION

30. OPEN-GLOBE INJURIES
Modes of injury
1. Trauma by sharp and pointed instruments like needles, knives, nails, arrows, screw-drivers, pens,
pencils, compasses, glass pieces and so on.
2. Trauma by foreign bodies travelling at very high speed such as bullet injuries and iron foreign bodies
in lathe workers.
Mechanisms of damage
1. Mechanical effects of the trauma or physical changes.
2. Introduction of infection.
3. Post-traumatic iridocyclitis. It is of frequent occurrence and if not treated properly can cause
devastating damage, a rare but most dangerous complication of a perforating injury
Trauma
ti
c lesions with management
1. Wounds of the conjunc
ti
va. These are common and usually associated with subconjunc
ti
val
haemorrhage. A wound of more than 3 mm should be sutured.
2. Wounds of the cornea. These can be divided into uncomplicated and complicated wounds.
i.Uncomplicated corneal wounds. These are not associated with prolapse of intraocular contents.
Treatment. A small central wound does not need s
ti
tching. The only treatment required is pad and
bandage with atropine and an
ti
bio
ti
c ointments. A large corneal wound (more than 2 mm) should
always be sutured.

31. ii.Complicated corneal wounds. These are associated with prolapse of iris, some
ti
mes lens
ma
tt
er and even vitreous.
Treatment. Corneal wounds with iris prolapse should be sutured a
ft
er abscising the iris. The
prolapsed iris should never be reposited; since it may cause infec
ti
on. When associated with lens
injury and vitreous loss, lensectomy and anterior vitrectomy may be performed along with repair
of the corneal wound.
CORNEAL TEAR WITH IRIS PROLAPSE

32. 3. Wounds of the sclera. These are usually associated with corneal wounds and should be managed as
above. In corneo-scleral tear,
fi
rst suture should be applied at the limbus.
4. Wounds of the lens. Extensive lens ruptures with vitreous loss should be managed as above. Small
wounds in the anterior capsule may seal and lead on to trauma
ti
c cataract.
5. A badly (severely) wounded eye. It refers to extensive corneo-scleral tears associated with
prolapse of the uveal
ti
ssue, lens rupture, vitreous loss and injury to the re
ti
na and choroid. Usually
there seems to be no chance of ge
tti
ng useful vision in such cases. So, preferably such eyes should
be excised.
INTRAOCULAR FOREIGN BODIES
Penetra
ti
ng injuries with foreign bodies are not infrequent. Seriousness of such injuries is compounded by
the reten
ti
on of intraocular foreign bodies (IOFB).
Common foreign bodies chips of iron and steel (90%), par
ti
cles of glass, stone, lead pellets, copper
percussion caps, aluminium, plas
ti
c and wood.
Modes of damage and lesions
A penetra
ti
ng/perfora
ti
ng injury with retained foreign body may damage the ocular structures by the
following modes:

33. A. Mechanical e
ff
ects.
B. Introduc
ti
on of infec
ti
on.
C. Reac
ti
on of foreign bodies.
D. Post-trauma
ti
c iridocycli
ti
s.
A. Mechanical e
ff
ects
Mechanical e
ff
ects depend upon the size, velocity and type of the foreign body. Foreign bodies
greater than 2 mm in size cause extensive damage. The lesions caused also depend upon the route of
entry and the site up to which a foreign body has travelled.
Trauma
ti
c lesions produced by intraocular foreign bodies include:
• Corneal or/and scleral perfora
ti
on, hyphaema, iris hole,
• Rupture of the lens and trauma
ti
c cataract,
• Vitreous haemorrhage and/or degenera
ti
on,
• Choroidal perfora
ti
on, haemorrhage and in
fl
amma
ti
on,
• Re
ti
nal hole, haemorrhages, oedema and detachment.
Loca
ti
ons of IOFB. Having entered the eye through the cornea or sclera a foreign body may be retained
at any of the following sites
1. Anterior chamber. In the anterior chamber, the IOFB usually sinks at the bo
tt
om. A
ti
ny foreign body
may be concealed in the angle of anterior chamber, and visualised only on gonioscopy.
2. Iris. Here the foreign body is usually entangled in the stroma.

34. 3. Posterior chamber. Rarely, a foreign body may sink behind the iris a
ft
er entering through pupil or
a
ft
er making a hole in the iris.
4. Lens. Foreign body may be present on the anterior surface or inside the lens. Either an opaque
track may be seen in the lens or the lens may become completely cataractous.
5. Vitreous cavity. A foreign body may reach here through various routes.
6. Re
ti
na, choroid and sclera. A foreign body may obtain access to these structures through corneal
route or directly from scleral perfora
ti
on.
7. Orbital cavity. A foreign body piercing the eyeballmay occasionally cause double perfora
ti
on and
come to rest in the orbital
ti
ssues.
Management of retained intraocular foreign bodies (IOFB)
Diagnosis. It is a ma
tt
er of extreme importance par
ti
cularly as the pa
ti
ent is o
ft
en unaware that a
par
ti
cle has entered the eye. To come to a correct diagnosis following steps should be taken:
1.History
2.Ocular examina
ti
on
3.Plain X-rays
4.B scan
5.CT
6.MRI

35. 1, ANTERIOR CHAMBER; 2, IRIS; 3, LENS;
4, VITREOUS; 5, RETINA; 6, CHOROID; 7,
SCLERA; 8, ORBITAL CAVITY
COMMON SITES FOR RETENTION OF AN
INTRAOCULAR FOREIGN BODY
DEPICTION OF ROUTES OF ACCESS OF
A FOREIGN BODY IN THE VITREOUS

36. TREATMENT
IOFB should always be removed, except when it is inert and probably sterile or when li
tt
le damage has
been done to the vision and the process of removal may be risky and destroy sight (e.g., minute FB in
the re
ti
na).
1. Foreign body in the anterior chamber. It is removed through a corresponding corneal incision directed
straight towards the foreign body.
2. Foreign body entangled in the iris
ti
ssue (magne
ti
c as well as non-magne
ti
c) is removed by performing
sector iridectomy of the part containing foreign body.
3. Foreign body in the lens.Magnet extrac
ti
on is usually di
ffi
cult for intralen
ti
cular foreign bodies.
Therefore, magne
ti
c foreign body should also be treated as non magne
ti
c foreign body. An extracapsular
cataract extrac
ti
on (ECCE) with intraocular lens implanta
ti
on should be performed. The foreign body may
be evacuated itself along with the lens ma
tt
er or may be removed with the help of forceps.
4.Foreign body in the vitreous and the re
ti
na is removed as follow:
i.Magne
ti
c removal. This technique is used to remove a magne
ti
c foreign body that can be well localized
and removed safely with a powerful magnet without causing much damage to the intraocular structures.

37. ii.Forceps removal with pars plana vitrectomy. This technique is used to remove all non-magne
ti
c foreign
bodies and those magne
ti
c foreign bodies that cannot be safely removed with a magnet. In this
technique, the foreign body is removed with vitreous forceps a
ft
er performing three-pore pars plana
vitrectomy under direct visualiza
ti
on using an opera
ti
ng microscope.
REMOVAL OF A MAGNETIC
INTRAOCULAR FOREIGN BODY
FROM POSTERIOR SEGMENT
REMOVAL OF A NON-MAGNETIC
FOREIGN BODY THROUGH PARS
PLANA

38. CHEMICAL INJURIES
Chemical injuries are by no means uncommon. These vary in severity from a transient irrita
ti
on of li
tt
le
signi
fi
cance to complete and sudden loss of vision.
Modes of chemical injury
These usually occur due to external contact with chemicals under following circumstances:
1. Domes
ti
c accidents, e.g., with ammonia, solvents, detergents and cosme
ti
cs.
2. Agricultural accidents, e.g., due to fer
ti
lizers, insec
ti
cides, toxins of vegetable and animal origin.
3. Chemical laboratory accidents, with acids and alkalies.
4. Deliberate chemical a
tt
acks, especially with acids to dis
fi
gure the face.
5. Self-in
fl
icted chemical injuries are seen in psychopaths.
Types of chemical injuries
In general, the serious chemical burns mainly comprise alkali and acid burns.
A. Alkali burns
• Alkali burns are among the most severe chemical injuries known to the ophthalmologists.
• Common alkalies responsible for burns are: lime, caus
ti
c potash or caus
ti
c soda and liquid ammonia
(most harmful).

39. Mechanisms of damage produced by alkalies includes:
1. Alkalies dissociate and saponify fa
tt
y acids of the cell membrane and, therefore, destroy the structure of
cell membrane of the
ti
ssues.
2. Being hygroscopic, they extract water from the cells, a factor which contributes to the total necrosis.
3. They combine with lipids of cells to form soluble compounds, which produce a condi
ti
on of so
ft
ening and
gela
ti
nisa
ti
on
B. Acid burns
• Acid burns are less serious than alkali burns.
• Common acids responsible for burns are: sulphuric acid, hydrochloric acid and nitric acid.
Chemical e
ff
ects. Strong acids cause instant coagula
ti
on of all the proteins which then act as a barrier and
prevent deeper penetra
ti
on of the acids into the
ti
ssues. Thus, the lesions become sharply demarcated.
Treatment of chemical burns
1. Prevent further damage
Immediate and thorough irriga
ti
on with the available clean water or saline delivered through an IV
tubing. Deliver minimum of 2 L of water in 20-30 minutes or un
ti
l pH is restored.
Mechanical removal of contaminant. • If any par
ti
cles are le
ft
behind, par
ti
cularly in the case of lime,
these should be removed carefully with a swab s
ti
ck.
• Removal of contaminated and necro
ti
c
ti
ssue.
• Necrosed conjunc
ti
va should be excised.
• Contaminated and necrosed corneal epithelium should be removed with a co
tt
on swab s
ti
ck.

40. A PATIENT WITH CHEMICAL INJURY
FACE INCLUDING EYE
2. Maintenance of favourable condi
ti
onsfor rapid and uncomplicated healing by following measures:
• Topical an
ti
bio
ti
c dropse.g., moxi
fl
oxacin 4-6
ti
mes a day to prevent infec
ti
on.
• Steroid eye drops
• Cycloplegics, e.g., atropine, may improve the comfort.
• Ascorbic acid, in the form of 10% sodium ascorbate eyedrops (4-5
ti
mes)
• Lubricant eyedrops (preserva
ti
ve free) should be used in abundance to promote the healing.
• Sodium citrate, used as 10% topical eyedrops stabilizes neutrophils and reduces collagenase release.

41. 3. Preven
ti
on of symblepharon can be done by using a glass shell or sweeping a glass rod in the fornices
twice daily.
4. Treatment of complica
ti
ons, as below:
• Secondary glaucoma should be treated by topical 0.5%
ti
molol, ins
ti
lled twice a day along with oral
acetazolamide 250 mg 3-4
ti
mes a day.
• Pseudopterygium, when formed, should be excised together with conjunc
ti
val autogra
ft
• Symblepharon needs surgical treatment.
• Corneal opacity may be treated by keratoplasty if adequate tear
fi
lm and stem cell popula
ti
on available.
• Keratoprosthesis remains a surgical op
ti
on in severely damaged eyes where keratoplasty is not
possible.
PTERYGIUM PSEUDOPTERYGIUM

42. THANKS