Burns of the Eye (Anterior Segment, or Front Portion)

Definition:  Chemical, Thermal, Radiation, and Electrical burns

Chemical Burns: Spilling of chemicals including:

• Alkali (tri-quaternion ammonium compounds)

• Lye

• Cements

• Acids (sulfuric, nitric) 

• Solvents

• Fuels (kerosene, jet, fuel oil)

• Paints

• Detergents (soap)

• Irritants (peroxide, mace) into one or both eyes.

Alkali burns:  most severe because they rapidly penetrate through the cornea and anterior chamber with cellular destruction resulting in a potential of permanent loss of vision. 

Acid Burns:  produce injury through localized damage to area of contact.

Signs/symptoms:

Mild burns:

• Fluorescein positive defects of the corneal surface

• Haziness of the cornea

• Normal appearing conjunctiva (no ischemia of conjunctiva or sclera)

Moderate burns:

• Focal areas of conjunctival chemosis

• Some corneal opacification due to corneal edema

• Minimal ischemia of the conjunctiva, iritis

• Burns to the periocular surfaces with eyelid edema

• Elevated intraocular pressure

Severe burns:

• Pronounced chemosis with conjunctival blanching

• Frank corneal edema and opacification

• Sloughing of corneal epithelium

• 2^nd and 3^rd degree burns of the periocular tissues.

Evaluation:

• Visual acuity

• Extensive history:

  • When the injury occurred

  • Chemical involved in exposure

  • Duration of exposure

  • Duration of irrigation

  • How long after exposure the chemical irrigation was begun. 

Treatment:

• Emergency:

  • Begin irrigation of the eyes immediately normal saline or water for at least 30 minutes. 

  • Mild topical anesthetic can be used to facilitate irrigation if patient cannot keep eyes open.

  • Evert the upper eyelid and irrigate, and irrigate under lower lid.

  • Remove all solid particles from under lids.   

  • After 5 to 10 minutes of irrigation and if litmus paper is available test ph of lower inside of lid.  Continue irrigation until ph is below or above a ph of 7.0.  

  • If no litmus available irrigate for 20 min 
    

• Mild to moderate burn:

  • Continue to irrigate until ph is 7 or if litmus paper is not available for 20 min and remove any particulate material that may be present under the lids. 

  • Cycloplegic drops tid (scopolamine ¼%).  Do not use phenylephrin

  • Topical antibiotic ointment (erythromycin) every 1-2 hours. 

  • Pressure patch

  • Oral pain medication

  • If intraocular pressure is elevated give diamox 250mg qid po. 

  • Artificial tears prn
    

• Severe burn treatment:

  • Transport as soon as possible

  • Antibiotic ointment as above with pressure patching

  • Cycloplegic as above

  • Pain medication up to and including morphine if necessary. 

  • Topical steroids if available (prednisolone acetate 1% every 3 to 4 hours)

  • Anti-glaucoma medications as above

  • Frequent tears

Thermal burns:

Usually involves injury to the lids.  Their treatment is similar to that of thermal injury in other parts of the body. 

Radiation Burns:

Definition:  Ultraviolet burns to the surface of eye lids and cornea

Ultraviolet radiation:  The most common cause of light induced eye injury usually associated with welding arcs, sun, sum lamps

Signs/symptoms:  

• Mild irritation of conjunctiva

• Foreign body sensation 

• Up to severe photophobia

• Pain

• Spasms of the lids

• Red eye

• Tearing

• Blurred vision

• Punctate epithelial defects

• May take 6-8 hours before symptoms appear

Differential Diagnosis:  

• Chemical exposure

• Exposure keratopathy (inadequate blinking or lid closure leading to corneal drying)

• Toxic keratopathy( medication overuse)

Work-up:

• Visual acuity

• History:

  • Welding

  • Sun exposure

  • Medications,

• Evert lids to look for foreign body.

Treatment:

• Cycloplegic drops (scopolamine ¼%, cyclopentolate1%)

• Antibiotic Ointment

• Oral pain medication

• Follow up in 24 hours.

Prognosis:  

• Usually better in 24-48 hours

• May require SIQ chit for the duration of the injury depending of severity of injury

This section provided by CAPT Robert B. North, Jr., MC, USN

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*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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