Ocular Chemical Injury Research Articles

Lesson to be learned

Pediatric ocular chemical injuries constitute a true ocular emergency and require urgent evaluation and treatment. We report a case of ocular chemical burn in an 11-month-old infant following contamination of ophthalmic eye drop vial with trichloroacetic acid. The child developed superficial corneal burn which was managed successfully with a favorable outcome.

Role of anterior segment optical coherence tomography angiography in the assessment of acute chemical ocular injury: a pilot animal model study

To examine the use of anterior segment-optical coherence tomography angiography (AS-OCTA) in the assessment of limbal ischemia in an animal model chemical ocular injury. We conducted a prospective study using an established chemical ocular injury model in 6 rabbits (12 eyes), dividing the cornea limbus into 4 quadrants. Chemical injury grade was induced based on extent of limbal injury (0 to 360 degrees) and all eyes underwent serial slit-lamp with AS-OCTA imaging up to one month. Main outcome measure was changes in AS-OCTA vessel density (VD) comparing injured and control cornea limbal quadrants within 24 h and at one month. AS-OCTA was able to detect differences in limbal VD reduction comparing injured (3.3 ± 2.4%) and control quadrants (7.6 ± 2.3%; p < 0.001) within 24 h of ocular chemical injury. We also observed that AS-OCTA VD reduction was highly correlated with the number of quadrants injured (r = − 0.89; p < 0.001; 95% CI − 5.65 to − 1.87). Corneal vascularization was detected by AS-OCTA in injured compared to control quadrants (10.1 ± 4.3% vs 7.0 ± 1.2%; p = 0.025) at 1 month. Our animal pilot study suggests that AS-OCTA was able to detect limbal vessel disruption from various severities of acute chemical insult, and in the future, could potentially serve as an adjunct in providing objective grading of acute ocular chemical injury once validated in a clinical trial.

Pediatric Ocular Injury Due to Hand Sanitizer Exposure: An Emerging Hazard.

The objective of this study was to describe the incidence and severity of ocular exposure to alcohol-based hand rub (ABHR) in children presenting to a tertiary medical center during the severe acute respiratory syndrome coronavirus 2 pandemic. A retrospective single-center observational study conducted from February 21, 2020, to October 11, 2020. Subjects 10 years or younger who presented with ABHR-induced ocular injury were included. The same period from 2019 was studied and a comparison was performed between the 2 years. Outcome measures included the number of subjects with ocular injury due to ABHR, extent of ocular epithelial defects, length of hospitalization and time to resolution. A total of 9 patients presented to the Pediatric Emergency Department after sustaining ocular chemical injuries from ABHR during this period. Treatment included immediate irrigation followed by topical antibiotics, steroids, and lubrication. Six children were discharged and followed as outpatients with no reported adverse ocular sequelae. Three patients exhibited epithelial defects involving 85% to 100% of the cornea, 30% to 75% of the conjunctiva and required inpatient treatment ranging from 4 to 11 days. All patients experienced a complete resolution of the ocular epithelial defects after 12 to 19 days. No long-term irreversible damage was observed and visual acuity returned to normal in all patients. The utilization of ABHR during the severe acute respiratory syndrome coronavirus 2 pandemic resulted in childhood ocular injury. Prompt treatment led to good visual outcomes. These products should be regarded as potentially toxic and stored out of the reach of young children.

Ocular Chemical Burn with an Unusual Presentation: A Case Report

Introduction: Ocular chemical injury is an ophthalmic emergency that may be challenging to manage. Here, we presented a case of persistent corneal astigmatism secondary to chemical burn with superficial limbal injury and no corneal involvement. Case Presentation: The case was a 36-year-old man who presented with a chemical acid injury in the right eye. He had sectorial superficial involvement of inferior limbus from 4 to 5 o'clock hours, and the cornea was clear. Corneal topography showed high irregular astigmatism that was not corrected with glass. In long-term follow-up, changes in topographic parameters happened very slowly. Conclusions: In conclusion, optical corneal changes should be considered in the ocular surface chemical burn, especially in sectorial involvement despite clear cornea.

Acute ocular chemical injury: a descriptive assessment and management review at St. John Eye Hospital, Jerusalem, Palestine

Background: The purpose of the study was to assess caregivers’ compliance with the management protocol for chemical injury at St. John Eye Hospital, Jerusalem. Material and methods: Charts of all new chemical injury patients who presented to St. John Eye Hospital, Jerusalem, between January and December 2019 were retrospectively reviewed. Data categories collected included: presentation, age, sex, injury, irrigation, lids, visual acuity, slit-lamp examination (SLE), management plan, and medications given. Data were stored and analysed using Excel. Results: Patients’ presentation date and time, sex, and age were recorded in over 90% of cases. The mechanism of injury and type of offending chemical were recorded in 65% of cases. The irrigating solution was identified in 50% of cases. Corrected visual acuity was recorded in both eyes in almost 50% of cases. Limbal ischemia was documented in 45% of cases, and intraocular pressure (IOP) was recorded in 25%. The management plan and explanation of the condition to patients were documented in less than 50% of cases. Antibiotics and steroids (drops/ointment) were prescribed in 92.5% of cases. Conclusions: The results of this study reveal that our documentation needs improvement for several parameters. Several recommendations were formulated: Emphasize to caregivers that irrigation must be done first. Corrected visual acuity should be attempted for both eyes in all cases, and reasons for not recording it should be documented. It is important to document and record limbus details, iris details, and IOP in all cases.

Determining the effect of ocular chemical injuries on topical drug delivery

Ocular chemical injuries (OCIs) commonly cause ocular damage and visual loss and treatment uses topical therapies to facilitate healing and limit complications. However, the impact of chemical injury on corneal barrier function and treatment penetration is unknown. Therefore, the aim of this study was to determine the effect of OCI on drug penetration and absorption. Porcine corneal explants were used to assess histological damage, electrical resistance, and the trans-corneal penetration/corneal adsorption of reference compounds (sodium fluorescein and rhodamine B) and dexamethasone. Corneal explants were injured with either 1 M sulfuric acid, or 1 M sodium hydroxide. Dexamethasone penetration was measured using high-performance liquid chromatography (HPLC) and that of fluorescein and rhodamine using fluorescence. Dexamethasone corneal adsorption was measured using enzyme-linked immunoabsorbant assay (ELISA). Both acid and alkaline injuries reduced trans-corneal electrical resistance. NaOH injury increased hydrophilic fluorescein penetration (NaOH 8.59 ± 1.50E–05 cm.min−1 vs. Hanks' Balanced Salt Solution (HBSS) 1.64 ± 1.01E–06 cm.min−1) with little impact on hydrophobic rhodamine B (1 M NaOH 6.55 ± 2.45E–04 cm.min−1 vs. HBSS 4.60 ± 0.972E–04 cm.min−1) and dexamethasone penetration (1 M NaOH 3.00 ± 0.853E–04 cm.min−1 vs. HBSS 2.69 ± 0.439E–04 cm.min−1). By contrast, H2SO4 decreased trans-corneal penetration of hydrophilic fluorescein (H2SO4 1.16 ± 14.2E–07 cm.min−1) and of hydrophobic dexamethasone (H2SO4 1.88 ± 0.646E–04 cm.min−1) and rhodamine B (H2SO4 4.60 ± 1.42E–05 cm.min−1). Acid and alkaline OCI differentially disrupted the corneal epithelial barrier function. Acid injury reduced penetration of hydrophobic dexamethasone and rhodamine B as well as hydrophilic fluorescein, which may translate clinically into reduced drug penetration after OCI, while alkaline injury increased fluorescein penetration, with minimal effect on dexamethasone and rhodamine B penetration.

Novel approach of autologous simple limbal epithelial transplantation (autoSLET) in eyes with acute unilateral severe ocular chemical injury

A 19-year-old boy was presented 4 days after left eye acute chuna injury grade 4 (Dua). BCVA was finger counting 1 m, limbal ischemia, ground glass cornea, and corneal epithelial defect involving adjacent conjunctiva. Autologous contralateral simple limbal epithelial transplantation (SLET) was performed. Complete ocular surface epithelization was noted at day 21. At 8-months follow-up, there was a stable ocular surface with 20/20p BCVA. AutoSLET achieves rapid epithelialization in severe chemical injuries thereby preventing adverse effects of delayed epithelial healing avoiding the need for visual rehabilitative procedures later. Larger case series with longer follow-up is required.

Assault-related severe ocular chemical injury at a London ophthalmic referral hospital: a 3-year retrospective observational study

ObjectivesTo understand the incidence, causes, management and outcomes of intentional (assault) and unintentional severe ocular chemical injuries (SOCI) at an urban tertiary referral centre in the UK.DesignRetrospective observational study.SettingA London...

Knowledge, Attitude, and Practices of Emergency Management of Ocular Chemical Injury Among Primary Responders

Introduction: Chemical injuries are considered as one of the true ocular emergencies where timely management can save vision and years of visual rehabilitation. Thus, knowledge of the injury and its management is very important for medical professionals as well as the general population.

Allogenic Simple Limbal Epithelial Transplantation Versus Amniotic Membrane Grafting in the Early Management of Severe-Grade Ocular Chemical Injuries—A Retrospective Comparative Study

To compare outcomes of management in the early stage of severe chemical injury (grade 4 and worse; Dua classification) with amniotic membrane grafting (AMG) alone vs allogenic simple limbal epithelial transplantation (alloSLET). Retrospective comparative interventional case series. Retrospective comparative interventional series. Records of patients with severe ocular chemical injury who underwent AMG alone (between 2009 and 2013) vs alloSLET (between 2013 and 2017) were analyzed for grade of injury, time of and interventions for epithelial healing, ocular surface status post healing (grade of symblepharon, and limbal stem cell deficiency [LSCD]), and type of and need for interventions in the chronic stage. Among patients presenting in early stage of severe chemical injury, 38 eyes (median age 11 years) managed with AMG alone were compared with 39 eyes (median age 8 years) managed with alloSLET. The mean time of presentation post injury was 33.85 ± 27.5 and 40.6 ± 23.5days in the AMG and alloSLET group, respectively. The rate of epithelial healing was faster in the alloSLET group and the difference was noted to be statistically significant (odds ratio [OR] 0.966, P= .001). Similarly, the lower occurrence of LSCD (OR 0.137, P= .004) and need for keratoplasty (OR 0.093, P= .003) favored alloSLET over AMG. Final best-corrected visual acuity of >20/200 was achieved in 39.4% and 53.8% in the AMG and alloSLET groups, respectively. AlloSLET helps in faster epithelialization of the surface, thus reducing the need for subsequent surgeries in the chronic stage and aiding faster visual rehabilitation. The outcomes of alloSLET appear superior to amniotic membrane grafting alone and should be considered in eyes with grade 4 and above (Dua classification) chemical injuries in the early stage.

Glaucoma after ocular chemical burns: Incidence, risk factors, and outcome

Effects of chemical injuries on the cornea and limbus have been widely studied; however, little is known about glaucoma after ocular chemical injuries. We herein investigated the incidence, risk factors, and outcome of glaucoma in patients with ocular chemical burns. Medical records were reviewed of patients who visited our clinic for chemical injuries to the ocular surface. Patients were divided into glaucoma and non-glaucoma groups based on high intraocular pressure (IOP) readings. Clinical characteristics, treatment method, and therapeutic and visual outcomes were compared between the two groups. Of 29 patients (40 eyes), 9 patients (15 eyes, 37.5%) were diagnosed with glaucoma at 2.64 ± 2.92 months after injury. Factors associated with glaucoma included male gender (p = 0.0114), bilateral ocular involvement (p = 0.0478), severe ocular surface involvement (Dua grades IV-VI, p = 0.0180), poor initial visual acuity (p = 0.0136), high initial IOP (p < 0.0001), pupil involvement at initial examination (p = 0.0051), and the need for amniotic membrane transplantation in the acute stage (p = 0.0079). At final follow-up, IOP was uncontrolled in 3 eyes (20.0%), and visual acuity was worse in the glaucoma group than in the non-glaucoma group (logMAR 2.94 ± 1.86 vs 0.34 ± 0.69, p < 0.0001). These findings suggest that careful evaluation and intensive treatment for glaucoma are essential in patients with severe ocular burns.

Analysis of therapeutic effect of Bandage contact lens and autologous serum on occupational mild to moderate ocular chemical injury

目的： 探讨角膜绷带镜与自体血清联合应用在职业性轻中度眼部化学伤治疗中的效果。 方法： 以2017年1月~2018年10月中国医科大学第八临床学院鞍钢总医院接收的职业性轻中度眼部化学伤37例（60只眼）患者为研究对象，其中18例（30眼）为对照组，19例（30眼）为观察组，两组均局部给予清除坏死组织、抗感染、营养角膜等对症治疗，观察组在此基础上给予角膜绷带镜与自体血清联合应用治疗，随访5个月，观察两组病例的临床治疗效果并进行统计学分析。 结果： 观察组病例角膜上皮修复时间为（5.50±1.78）d，对照组为（10.53±3.30）d，与对照组比较，观察组病例角膜上皮修复所用时间明显减少（P<0.05）；观察组病例治疗总有效率为96.67%（29/30），对照组为70.0%（21/30），与对照组比较，观察组病例临床治疗总有效率明显升高（P<0.05）；观察组病例并发症发生率为3.33%（1/30），对照组为26.67%（8/30），与对照组比较，观察组病例并发症发生率明显降低（P<0.05）。 结论： 角膜绷带镜与自体血清联合应用可以减轻患者的眼部刺激症状，减少角膜上皮修复时间，减少并发症的发生，且安全性较高。.

Clinical characteristics of patients hospitalized for ocular chemical injuries in Shanghai from 2012 to 2017

PurposeTo summarize the clinical characteristics of patients with ocular chemical injuries and evaluate their potential relationship with the visual outcome by analyzing the medical records of these patients from January 1, 2012, to December 31, 2017.MethodsThis is a retrospective case series study. Patient data included age, gender, occupational classification, location of ocular chemical injury, initial and final best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), nature and chemical phase, distribution and severity of chemical injury, management methods, and complications. All variables were evaluated for their potential relationship with visual outcome.ResultsA total of 160 patients were hospitalized with ocular chemical injuries. Majority of the patients were factory workers and arrived at the consultation room less than 24 h after injury. The most common ocular injury setting, classification of severity, causative chemical, chemical phase, and complications were workplace, grade II, unknown and mixed substance, liquid, and elevated IOP, respectively. The risk factors for poor final BCDVA were identified as older age, poor initial BCDVA, and irrigation 24 h after injury (P < 0.001, P < 0.001, and P = 0.011, respectively).ConclusionsWe elaborate the clinical characteristics and outcomes of patients with ocular chemical injuries in Jinshan District, Shanghai. A comprehensive education program should be established and the use of protective eyewear should be promoted to prevent occupation-related ocular chemical injuries.

Electrospun Collagen-based Scaffold as Therapeutic Agent for Ocular Chemical Injury

Ocular chemical injury hit on cornea and conjunctiva due to chemical contact. This injury damages to the epithelial surface of the eye, cornea, anterior segment and permanent unilateral or bilateral permanent viscous damage). Nowadays, human amniotic membrane, allograft biomaterials is used as the treatment for the injury. However, this method has many obstacles. Collagen-based Scaffold is a new study of electrospinning membrane made of collagen, hyaluronic acid, and polyethylene oxide. This research is aimed to obtain the optimum concentration of polymer solution that produces the best morphology in the formation of electrospun collagen-based scaffold. The result show that the fiber had mean diameter of 212, 63 nm to 500, 8 nm and mean pore diameter 498, 56 until 2788 nm. FTIR test shows the loss of functional groups Amide A and Amide II indicate successful crosslinking process with glutaraldehyde. The cytotoxicity test showed electrospun collagen-based scaffold was nontoxic.

The proteolytic fraction from Vasconcellea cundinamarcensis accelerates wound healing after corneal chemical burn in rabbits.

Chemical ocular burns are among the most frequently eye-related injuries, which require immediate and intensive evaluation and care since they may lead to potential complications such as superinfection, corneal perforation, and blindness.Vasconcellea cundinamarcensis, a species from Caricaceae family, contains highly active proteolytic enzymes in its latex that show healing activity in animal models bearing lesions of different etiologies. We evaluate the ocular toxicity of the proteolytic fraction from V. cundinamarcensis (P1G10) by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and Hen's Egg Test-Chorioallantoic Membrane test. The corneal healing property of P1G10 was studied by the ethanol-chemical burn in the rabbit's eyes. P1G10 is safe for ocular administration, except when administrated at 10μg/mL. P1G10 at 1μg/mL accelerates the corneal re-epithelization achieving complete wound closure after 72h of chemical burn. Also, P1G10 modulated the inflammatory response and controlled the arrangement of collagen fibers in the stroma, demonstrating its potential corneal healing properties. Our work was the first one to evaluate the ophthalmic application of P1G10. Here we demonstrated that P1G10 is suitable for ocular administration and it has a promising corneal healing activity which may emerge as a new pharmacological tool to the development of a new drug for ocular surface chemical injuries in the future.

NEXAGON for the Treatment of Corneal Persistent Epithelial Defects Following Severe Ocular Chemical and/or Thermal Injuries

NEXAGON for the Treatment of Corneal Persistent Epithelial Defects Following Severe Ocular Chemical and/or Thermal Injuries

Ocular chemical injuries from laundry detergent pods in children

Ocular chemical injuries from laundry detergent pods in children

Management and outcome of a case of severe ocular chemical injury

Ocular chemical injuries may produce extensive damage to surface epithelium,cornea &amp; anterior segment of eye. Most severe injuries have an unfavorable prognosis, but timely &amp; optimal surgical management like Amniotic membrane grafting, Stem cell transplantation, penetrating keratoplasty and in indicated cases, a keratoprosthesis.This case report presents a case of bilateral alkali injury, the management of which was a long drawn &amp; challenging process.

Clinical profile &amp; visual outcome in ocular chemical injury

Clinical profile &amp; visual outcome in ocular chemical injury

An update on chemical eye burns.

Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as keychallenges. Education and prevention are therefore importantpublic health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherencerates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.