Abstract
PurposeThere is currently uncertainty about the most efficacious decontamination solution for corrosive chemical eye burns. This 30-year longitudinal study evaluated the relative efficacy of two different decontamination methods. Passive decontamination consists of rinsing with tap water, 0.9% normal saline, isotonic buffered phosphate solution, or Ringer’s lactate. Active decontamination adds an amphoteric, polyvalent, and chelating component with Previn® (Diphoterine®) solution (Laboratoire Prevor, Valmondois, France).MethodsA prospective evaluation of patients treated in two specialized eye clinics for eye burns was begun in 1988. Recorded data included exposure circumstances, type of corrosive, different types of first therapy, and clinical treatment and outcome. Patients were treated from clinic admission and up to 24 h after the corrosive chemical burn with rinsing for 15 min using two different protocols. From 1988 to 2005, sterile 0.9% normal saline or Ringer’s lactate was used. Since 2006, sterile, hypertonic, amphoteric Previn® solution was used. Comparative statistical analysis was done with the Fisher contingency tables and Wilcoxon tests.ResultsThere were a total of 1495 patients with 2194 chemically burned eyes. In 1988–2005, the annual incidence was 66.1/year; in 2006–2017, it was 65.5/year. Similar incidences were noted when initial rinsing was with tap water or isotonic buffered phosphate solutions. There was a significantly more severe outcome of corrosive chemical eye burns with any first aid rinsing solutions other than Previn® solution or tap water was used (p < 0.001). Previn® solution or tap water rinsing in the pre-hospital setting and secondary rinsing with Previn® solution in the hospital decreased lesion severity in comparison with all other rinsing solutions (p < 0.001).ConclusionThe frequency of corrosive chemical eye burns was comparatively high despite tightening of occupational health and safety regulations over the past 30 years. The severity of corrosive chemical eye burns has been dramatically decreased since the introduction of Previn® solution for initial and secondary rinsing. A new protocol for immediate Previn® solution use by the Cologne Fire Brigade and secondary Previn® solution rinsing in hospital has reduced the frequency of severe corrosive chemical eye burns to less than 60% as compared to the period of 1988–2005 when other rinsing solutions were utilized.
Highlights
Pauwelsstr. 30, D-52057 Aachen, GermanyThe optimal first aid measures immediately after corrosive chemical eye burns have long been the subject of discussion
Another prefers eye rinsing with various sterile electrolyte solutions such as 0.9% normal saline, Ringer’s lactate, BSS, saline solution, isotonic or hypertonic buffered phosphate solution, or isotonic buffered borate solution
The current study found differences compared to a large American study of more than 160,000 eye burns which noted more burns in the domestic setting, slightly more men than women so injured, an average age of 32–33 years, and greater numbers of affected children [15]
Summary
Pauwelsstr. 30, D-52057 Aachen, GermanyThe optimal first aid measures immediately after corrosive chemical eye burns have long been the subject of discussion. Best clinical practice consensus is that eye rinsing, as soon as possible after a corrosive chemical ocular splash, should be done with a neutral pH aqueous flushing solution [1]. It is common practice to utilize eye rinsing, as soon after the exposure as can be done, to remove as much corrosive chemical as possible and preserving the pH milieu of the Graefes Arch Clin Exp Ophthalmol (2019) 257:1795–1803 anterior chamber. Current debate is over which ringing solutions(s) is/are most efficacious in preventing or mitigating potentially serious ocular injuries following a corrosive chemical eye splash. One school of thought endorses eye rinsing with large amounts of tap, distilled, or sterile water. A third advocates specialized rinsing fluids such as sterile, water-based, polyvalent, chelating, amphoteric solutions
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