Chemical Injuries/Burn

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This  is  an  Ophthalmological  emergency.  It  occurs  when  chemicals  such  as  acid  or  alkali  (e.g.  household detergents, bleaching agents), snake spit, insect bite, traditional eye medicine, cement or  lime cause a damage to the eye.   

Clinical presentation 

  • Diagnosis relies mostly with patients’ history
  • Patients may present with photophobia
  • Inability to open the eyes
  • Excessive tearing/watery eye
  • Cloudiness  of  cornea  with  blurred vision
  • Loss of conjunctival blood vessels
  • Traces of chemical substance such as cement or herbs and blisters or loss  of  eyelid  skin  in  open  flame injuries.

Investigations 

  • Visual acuity
  • Slit lamp bimicroscopy
  • Fluorescein staining

Non-pharmacological Treatment 

If  a  patient  gives  you  history  of  being  in  contact  with  the  items  mentioned  above,  the  following  should be done: 

  • Irrigate  the  eye  with  clean  water  or  Ringers  lactate  continually  for  a  minimum  of  20–30 minutes to reduce chemical substances. Irrigate longer for severe alkali burn.
  • Test the patients’ vision and examine the patient’s eye

Pharmacological Treatment 

C:  tetracaine  0.5%  eye  drops,  instill  2  drops  in  the  affected  eye.  Repeat  irrigation  if possible. Evert the eye lids and remove the debris 

AND 

A: chloramphenicol 1% eye ointment, apply 6hourly to prevent infection for 3days. 

AND 

A:  paracetamol  (PO)1gm  4–6hourly  to  a  maximum  of  4  doses  in  24hours,  for  3days  in adults, the dosage in children is 10–14mg/kg 4–6hourly for 3days 

Referral: Refer all cases within 12hours to eye specialist at high level health facilities for more care