Burn of the cornea. Thermal burn of the cornea and conjunctiva
RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015
Thermal and chemical burns limited to the eye and adnexa (T26)
Ophthalmology
general information
Short description
Recommended
Expert Council
RSE on PVC "Republican Center for Health Development"
Ministry of Health
and social development
dated October 15, 2015
Protocol #12
Burns limited to the area of the eye and its adnexa- this is a lesion of the eyeball and tissues around the eye due to chemical, thermal and radiation damaging agents.
Protocol name: Thermal and chemical burns limited to the area of the eye and its adnexa.ICD-10 code(s):
T26.0 Thermal burn of eyelid and periorbital region
T26.1 Thermal burn of cornea and conjunctival sac
T26.2 Thermal burn resulting in laceration and destruction of eyeball
T26.3 Thermal burn of other parts of eye and adnexa
T26.4 Thermal burn of eye and adnexa, unspecified
T26.5 Chemical burn of eyelid and periorbital region
T26.6 Chemical burn of cornea and conjunctival sac
T26.7 Chemical burn leading to laceration and destruction of eyeball
T26.8 Chemical burns of other parts of eye and adnexa
T26.9 Chemical burn of eye and adnexa, unspecified
Abbreviations used in the protocol:
ALT - alanine aminotransferase
In / in - intravenously
V\m - intramuscularly
GKS - glucocorticosteroids
INR - international normalized ratio
P\b - parabulbarno
P \ to - subcutaneously
PTI - prothrombin index
UD - level of evidence
ECG - electrocardiographic study
Date of development/revision of the protocol: 2015
Protocol Users: therapists, pediatricians, general practitioners, ophthalmologists.
Evaluation of the evidence level of the given recommendations.
Evidence level scale:
|
Level evidence |
Type Evidence |
|
The evidence comes from a meta-analysis of a large number of well-designed randomized trials. Randomized trials with low false-positive and false-negative errors. |
|
| The evidence is based on the results of at least one well-designed, randomized trial. Randomized Trials with High False Positive and False Negative Error Rates | |
|
III |
The evidence is based on well-designed, non-randomized studies. Controlled studies with one group of patients, studies with a historical control group, etc. |
| The evidence comes from non-randomized trials. Indirect comparative, descriptively correlated and case studies | |
| V | Evidence based on clinical cases and examples |
Classification
Clinical classification
Depending on the influencing factor:
· chemical;
· thermal;
radiation;
combined.
According to the anatomical localization of damage:
Auxiliary organs (eyelids, conjunctiva);
eyeball (cornea, conjunctiva, sclera, deeper structures);
several related structures.
By severity of damage:
I degree - easy;
II degree - medium degree;
III (a and b) degree - severe;
IV degree - very severe.
Diagnostics
The list of basic and additional diagnostic measures:
Diagnostic measures taken at the stage of emergency care:
Collection of anamnesis and complaints.
The main (mandatory) diagnostic examinations carried out at the outpatient level:
Visometry (UD - C);
Ophthalmoscopy (UD - C);
biomicroscopy of the eye (UD - C).
Additional diagnostic examinations performed at the outpatient level:
perimetry (UD - C);
Tonometry (UD - C);
echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C);
The main (mandatory) diagnostic examinations carried out at the hospital level during emergency hospitalization and after more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
collection of complaints, anamnesis of the disease and life;
· general blood analysis;
· general urine analysis;
biochemical blood test (total protein, its fractions, urea, creatinine, bilirubin, ALT, AST, electrolytes, blood glucose);
· coagulogram (PTI, fibrinogen, FA, clotting time, INR);
microreaction;
blood test for HIV by ELISA;
determination of HBsAg in blood serum by ELISA;
determination of total antibodies to hepatitis C virus in blood serum by ELISA;
determination of the blood group according to the ABO system;
Determination of the Rh factor of the blood;
Visometry (UD - C);
Ophthalmoscopy (UD - C);
Determination of corneal surface defects (UD - C);
biomicroscopy of the eye (UD - C);
EKG.
Additional diagnostic examinations carried out at the hospital level during emergency hospitalization and after more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
perimetry (UD - C);
Tonometry (UD - C);
echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C) *;
X-ray of the orbit (if there are signs of combined damage to the eyelids, conjunctiva and eyeball, to exclude foreign bodies) (UD - C).
Diagnostic criteria for making a diagnosis:
Complaints and anamnesis
Complaints:
pain in the eye
lacrimation;
severe photophobia;
· blepharospasm;
Decreased visual acuity.
Anamnesis:
Finding out the circumstances of the eye injury (type of burn, type of chemical).
Instrumental research:
visometry - decreased visual acuity;
biomicroscopy - violation of the integrity of the structures of the eyeball, depending on the severity of the damage;
Ophthalmoscopy - weakening of the reflex from the fundus;
Determination of defects in the surface of the cornea - the area of damage to the cornea, depending on the severity of the burn;
Indications for consultation of narrow specialists:
consultation of a therapist - to assess the general condition of the body.
Differential Diagnosis
differential diagnosis.
Table - 1. Differential diagnosis of eye burns according to severity
| Burn degree | Leather | Cornea | Conjunctiva and sclera |
| I | hyperemia of the skin, superficial exfoliation of the epidermis. | islet staining with fluorescein, dull surface | hyperemia, islet staining |
| II | blistering, peeling of the entire epidermis. | film that is easily removed, deepithelialization, continuous staining. | pallor, gray films that are easily removed. |
| III a | necrosis of the superficial layers of the skin itself (up to the germ layer) | superficial clouding of the stroma and Bowman's membrane, folds of the Descemet's membrane (if its transparency is preserved). | pallor and chemosis. |
| 3rd century | necrosis of the entire thickness of the skin | deep clouding of the stroma, but without early changes in the iris, a sharp violation of sensitivity in the limbus. | exposure and partial rejection of the deathly pale sclera. |
| IV | deep necrosis of not only the skin, but also the subcutaneous tissue, muscles, cartilage. | simultaneously with changes in the cornea up to detachment of the Descemet's membrane ("porcelain plate"), depigmentation of the iris and immobility of the pupil, clouding of the moisture of the anterior chamber and lens. | melting of the exposed sclera to the vascular tract, clouding of the moisture of the anterior chamber and the lens, the vitreous body. |
Table - 2. Differential diagnosis of chemical and thermal eye burns
| Nature of damage | alkali burn | acid burn |
| type of damage | colliquational necrosis | coagulative necrosis |
| intensity of primary corneal opacity | weakly expressed | strongly expressed |
| damage depth | clouding of the cornea does not correspond to the depth of tissue damage | clouding of the cornea corresponds to the depth of tissue damage |
| damage to the structures of the eye | rapid | slow |
| development of iridocyclitis | rapid | slow |
| neutralizers |
2% boric acid solution |
3% solution of bicarbonate soda |
Treatment
Treatment goals:
Reduction of the inflammatory reaction of the tissues of the eye;
relief of pain syndrome;
restoration of the surface (epithelization) of the eye.
Treatment tactics:
For burns of the 1st degree - treatment is carried out on an outpatient basis, under the supervision of an ophthalmologist;
In case of burns of II-IV degrees - emergency hospitalization in a hospital is indicated.
Medical treatment:
Drug treatment provided at the stage of emergency emergency care:
Medical treatment provided on an outpatient basis (for burnsI degree) :
· in the presence of a powdered chemical or its pieces on the eyelids and conjunctiva, remove it with damp cotton or gauze;
local anesthetics (oxybuprocaine 0.4% or proximethacaine 0.5%) 1-2 drops in the conjunctival cavity once (UD - C);
Abundant, prolonged (at least 20 minutes), washing of the conjunctival cavity with cool (12 0 -18 0 C) running water or water for injection (during washing, the patient's eyes must be open);
midriatics (the choice of drugs is at the discretion of the doctor) - cyclopentolate 1%, tropicamide 1%, ophthalmic phenylephrine 2.5% and 10% epibulbarno 1-2 drops up to 3 times a day for 3-5 days in order to prevent the development of inflammatory process in the anterior vascular tract (UD - C);
Medical treatment provided at the hospital level:
burnsIIdegrees:
local anesthetics (oxybuprocaine 0.4% or proximethacaine 0.5%) instillations before washing the conjunctival cavity, immediately before surgery, pain relief if necessary (LE - C);
In case of a chemical burn, abundant, prolonged (at least 20 minutes), continuous irrigation of the conjunctival cavity with an alkali neutralizer (2% boric acid solution or 5% citric acid solution or 0.1% lactic acid solution or 0.01% acetic acid solution), for acids ( 2% sodium bicarbonate solution). Chemical neutralizers are used during the first hours after a burn; in the future, the use of these drugs is inappropriate and can have a damaging effect on the burned tissue (LE - C);
In case of a thermal burn, rinse with cool (120-180C) running water / water for injection (during the rinse, the patient's eyes should be open).
washing is not carried out with a thermochemical burn when a penetrating wound is detected;
local antibacterial agents (ophthalmic chloramphenicol 0.25% or ophthalmic ciprofloxacin 0.3% or ofloxacin ophthalmic 0.3%) - for children over 1 year old and adults immediately after washing the conjunctival cavity, as well as 1 drop 4 times a day epibulbarno in within 5-7 days (for the prevention of infectious complications) (UD - C);
Antibacterial agents for topical external use (ofloxacin ophthalmic 0.3% or tobramycin 0.3%) - for children over 1 year old and adults 2-3 times a day on the burn surface (according to indications) (UD - C);
non-steroidal anti-inflammatory drugs (diclofenac ophthalmic 0.1%) - 1 drop 4 times a day epibulbarno (in the absence of epithelial defects) for 8-10 days. (UD - C);
mydriatics - ophthalmic atropine 1% (adults), 0.5%, 0.25%, 0.125% (children) 1 drop 1 time per day epibulbarno, cyclopentolate 1%, tropicamide 1%, phenylephrine ophthalmic 2.5% and 10% epibulbarno 1-2 drops up to 3 times a day for the prevention and treatment of the inflammatory process in the anterior vascular tract (UD - C);
Regeneration stimulants, keratoprotectors (dexpanthenol 5 mg) - 1 drop 3 times a day epibulbarno. In order to improve the trophism of the anterior surface of the eyeball, accelerate the healing of erosions (UD - C);
With an increase in intraocular pressure: non-selective "B" blockers (timolol 0.25% and 0.5%) -. Contraindicated in: bronchial obstruction, bradycardia less than 50 beats per minute, systemic hypotension; Carbonic anhydrase inhibitors (dorzolamide 2%, or brinzolamide 1%) - epibulbarno 1 drop 2 times a day (UD - C);
for pain - analgesics (ketorolac 1 ml IM) as needed (UD - C);
burnsIII-
IVdegrees(in addition to the above, additionally assigned):
Anti-tetanus serum 1500-3000 IU s / c to reduce intoxication when the burn wound is contaminated;
Non-steroidal anti-inflammatory drugs - diclofenac inside 50 mg 2-3 times a day before meals, course 7-10 days (UD - C);
GCS (dexamethasone 0.4%) p / b 0.5 ml daily / every other day (not earlier than 5-7 days - according to indications, not in the acute phase triamcinolone 4% 0.5 ml p / b 1 time). With anti-inflammatory, decongestant, anti-allergic, anti-exudative purpose (UD - C);
Antibacterial drugs (according to indications for severe burns in the 1st and 2nd stage of burn disease) enterally / parenterally - azithromycin 250 mg, 500 mg - 1 TB 2 times a day for 5-7 days, 0.5 or 0.25 ml in / in 1 once a day for 3 days; cefuroxime 750 mg twice daily for 5–7 days, ceftriaxone 1.0 IV once daily for 5–7 days (LE-C).
Non-drug treatment:
General mode II-III, table No. 15.
Surgical intervention:
Surgical interventions for eye burnsIII-
IV stages:
conjunctivotomy;
necrectomy of the conjunctiva and cornea;
blepharoplasty, blepharorrhaphy;
· Layered and penetrating keratoplasty, biocovering of the cornea.
Surgical intervention provided in a hospital:
Conjunctivotomy(ICD-9: 10.00, 10.10, 10.33, 10.99) :
Indications:
Pronounced swelling of the conjunctiva;
Risk of limbal ischemia.
Contraindications:
general somatic status.
Necrectomy of the conjunctiva and cornea(ICD-9: 10.31, 10.41, 10.42, 10.43, 10.44, 10.49, 10.50, 10.60, 10.99, 11.49) .
Indications:
·
the presence of foci of necrosis.
Contraindications:
general somatic status.
Blepharoplasty(early primary), blepharorrhaphy(ICD-9: 08.52, 08.59, 08.61, 08.62, 08.64, 08.69, 08.70, 08.71, 08.72, 08.73, 08.74, 08.89, 08.99):
Indications:
Severe burn injuries of the eyelids, with the impossibility of complete closure of the palpebral fissure;
Contraindications:
general somatic status.
Keratoplasty layered / through, bio-covering the cornea(ICD-9: 11.53, 11.59, 11.61, 11.62, 11.63, 11.64, 11.69, 11.99).
Indications:
Threat of perforation / perforation of the cornea, with a therapeutic and organ-preserving purpose.
Contraindications:
general somatic status.
Further management:
· for burns of mild severity, outpatient treatment under the supervision of an ophthalmologist of an outpatient-polyclinic level;
After the end of inpatient treatment, the patient enters the dispensary registration with an ophthalmologist at the place of residence (up to 1 year) with the necessary recommendations (volume and frequency of dispensary examinations).
Reconstructive surgery (not earlier than a year after the injury) - eyelid surgery, conjunctival cavity surgery, keratoprosthetics, keratoplasty.
Treatment effectiveness indicators:
relief of the inflammatory process;
Complete epithelialization of the cornea;
restoration of the transparency of the cornea;
Improvement of visual functions;
absence of cicatricial changes of the eyelid and conjunctiva;
absence of secondary complications;
Formation of a vascularized corneal leukoma.
Drugs (active substances) used in the treatment
| Azithromycin (Azithromycin) |
| Atropine (Atropine) |
| Boric acid |
| Brinzolamide (Brinzolamide) |
| Dexamethasone (Dexamethasone) |
| Dexpanthenol (Dexpanthenol) |
| Diclofenac (Diclofenac) |
| Dorzolamide (Dorzolamide) |
| Ketorolac (Ketorolac) |
| Citric acid |
| Lactic acid |
| Sodium bicarbonate (Sodium hydrocarbonate) |
| Oxybuprocaine (Oxybuprocaine) |
| Ofloxacin (Ofloxacin) |
| Proxymetacaine (Proxymetacaine) |
| Anti-tetanus serum (Serum tetanus) |
| Timolol (Timolol) |
| Tobramycin (Tobramycin) |
| Tropikamid (Tropikamid) |
| Acetic acid |
| Phenylephrine (Phenylephrine) |
| Chloramphenicol (Chloramphenicol) |
| Ceftriaxone (Ceftriaxone) |
| Cefuroxime (Cefuroxime) |
| Cyclopentolate (Cyclopentolate) |
| Ciprofloxacin (Ciprofloxacin) |
Hospitalization
Indications for hospitalization, indicating the type of hospitalization:
Indications for emergency hospitalization:
burns of the eyes and its appendages of moderate or more severity.
Indications for planned hospitalization: No
Information
Sources and literature
- Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
- List of used literature (valid research references to the listed sources are required in the text of the protocol): 1) Eye diseases: textbook / Under. ed. V.G. Kopaeva. - M.: Medicine, 2002. - 560 p. 2) Jaliashvili O.A., Gorban A.I. First aid for acute diseases and injuries of the eye. - 2nd ed., revised. and additional - St. Petersburg: Hippocrates, 1999. - 368 p. 3) Puchkovskaya N.A., Yakimenko S.A., Nepomnyashchaya V.M. Eye burns. - M.: Medicine, 2001. - 272 p. 4) Ophthalmology: national leadership / Ed. C.E. Avetisova, E.A. Egorova, L.K. Moshetova, V.V. Neroeva, Kh.P. Takhchidi. - M.: GEOTAR-Media, 2008. - 944 p. 5) Egorov E.A., Alekseev V.N., Astakhov Yu.S., Brzhesky V.V., Brovkina A.F., et al. Rational pharmacotherapy in ophthalmologists: a guide for practitioners / Ed. ed. E.A. Egorova. – M.: Litterra, 2004. – 954 p. 6) Atkov O.Yu., Leonova E.S. Plans for the management of patients "Ophthalmology" Evidence-based medicine, GEOTAR - Media, Moscow, 2011, P.83-99. 7) Guideline: Work Loss Data Institute. eye. Encinitas (CA): Work Loss Data Institute; 2010. Various p. 8) Egorova E.V. et al. Technology of surgical interventions for extensive post-traumatic defects and deformities in the eyelid area \\ Mater. 111 Euro-Asian Conf. in ophthalmic surgery. - 2003, Yekaterinburg. - with. 33
Information
List of protocol developers with qualification data:
1) Isergepova Botagoz Iskakovna - Candidate of Medical Sciences, Head of the Department of Management of Scientific and Innovative Research of JSC "Kazakh Research Institute of Eye Diseases".
2) Makhambetov Dastan Zhakenovich - ophthalmologist of the 1st category, JSC "Kazakh Research Institute of Eye Diseases".
3) Mukhamedzhanova Gulnara Kenesovna - Candidate of Medical Sciences, Assistant of the Department of Ophthalmology of the RSE on REM "Kazakh National Medical University Asfendiyarova S.D.
4) Zhusupova Gulnara Darigerovna - Candidate of Medical Sciences, Associate Professor of the Department of JSC "Astana Medical University".
Indication of no conflict of interest: No
Reviewer: Shusterov Yury Arkadyevich - Doctor of Medical Sciences, Professor, RSE on REM "Karaganda State Medical University", Head of the Department of Ophthalmology.
Indication of the conditions for revising the protocol:
Revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.
Attached files
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Chemical burns of the organs of vision occur due to contact with aggressive chemical reagents. They lead to damage to the anterior part of the eyeball, cause unpleasant symptoms: pain, irritation, and can lead to vision problems.
Main features
An eye burn is not a disease, but a pathological condition that can be completely eliminated if you turn to an ophthalmologist in time.
List of symptoms:
- Sharp pain in the eyes. But why there is pain in the eyeball when pressed, this will help to understand
- Redness of the conjunctiva.
- Discomfort, burning sensation, irritation.
- Increased tearing.
It is difficult not to notice the chemical damage to the organ of vision. It's all about the pronounced symptoms, which gradually increase.
Substances of a chemical nature acts gradually. Once on the skin of the eyes, they cause irritation, but if you leave the burn unattended, then its manifestations will only intensify.
Aggressive reagents gradually cause damage to the skin of the eyelids and the eye. It is possible to assess the degree of the inflicted "injuries" and their severity in 2-3 days. But what are the diseases of the eyelids of the eyes in humans and what drops should be used, indicated in this
Burn classification
On the video - a description of a chemical burn of the eye:
Clinical manifestations
- Damage to the surface of the skin of the eyelids.
- The presence of foreign substances in the tissues of the conjunctiva. But what can be the symptoms of eye conjunctivitis in children, you can see
- Increased intraocular pressure (ocular hypertension).
Abundant damage to the skin occurs upon contact with reagents. Substances irritate the mucous membrane, which leads to redness and irritation of the anterior sections of the eyeball.
Ophthalmological examination reveals particles of foreign substances, they are clearly visible during clinical examination. Conducting research helps to establish which substance led to the development of damage (acid, alkali).
Reagents act on the parts of the eyeball in a special way. Contact leads to "drying" or drying of the mucous surface and an increase in the level of intraocular pressure. But what are the symptoms in adults of increased eye pressure, is described in great detail in this
Evaluation of the totality of symptoms helps to make the correct diagnosis for the patient. The ophthalmologist determines the degree of the burn, performs diagnostic procedures and selects an adequate treatment.
ICD-10 code
- T26.5- a chemical burn and the area around the eyelid;
- T26.6- a chemical burn with reagents with damage to the cornea and conjunctival sac;
- T26.7- severe chemical burn with tissue damage, leading to rupture of the eyeball;
- T26.8- a chemical burn that affected other parts of the eye;
- T26.9- a chemical burn that affected the deep parts of the eyeball.
First aid
If the tissues of the eyeball, tissues of the eyelids and conjunctiva are damaged, the patient needs first aid.
So, the principles of its provision:
Do not wash your eyes with running water, use cosmetic creams. This can lead to increased signs of chemical exposure.
Once on the skin, the cream creates a protective shell from above, as a result of which the action of aggressive reagents is enhanced. For this reason, you should not apply creams or other cosmetic products to the skin.
What drugs can be used:
Potassium permanganate solution should be weak, it will help neutralize the action of aggressive substances. You can dilute potassium permanganate, prepare furatsilin, or simply rinse your eyes with warm, slightly salted water.
Rinse your eyes as often as possible, every 20-30 minutes. If the symptoms are pronounced, then you can take painkillers: Ibuprofen, Analgin or any other painkillers.
Treatment
It is advisable to consult a doctor at the first signs of a chemical burn. The doctor will select adequate therapy and help reduce unaccepted symptoms.
Most often, the following drugs are prescribed for treatment:
Antiseptics are part of combination therapy, they stop the inflammatory process and contribute to the restoration of soft tissues, relieve swelling and redness.
Antibacterial drugs are prescribed to stop the inflammatory process. They contribute to the death of pathogenic microflora and accelerate the process of cell regeneration.
Glucocorticosteroids can also be attributed to anti-inflammatory drugs, they enhance the effect of antibacterial drugs and antiseptics. With regular use, the intensity of unpleasant symptoms is reduced.
Local anesthetics are used in the form of drops. They help reduce the intensity of the pain syndrome.
If there is an increase in the level of intraocular pressure (most often diagnosed by contact with alkalis), then medications are used that reduce the signs of intraocular hypertension.
Medicines based on human tears. They help to soften the irritated conjunctiva and reduce the signs of the inflammatory process, remove swelling and partially hyperthermia of the eyelid covers.
List of drugs prescribed for eye burns:
| Group of drugs: | Name: |
| Glucocorticosteroids: | Prednisolone, Hydrocortisone in the form of an ointment. |
| Antibiotics: | Tetracycline, Erythromycin ointment |
| Antiseptics: | Sodium chloride, Potassium permanganate. |
| Anesthetics: | Dicaine solution. |
| Preparations based on human tears: | Visoptic, Vizin. |
| Drugs that reduce the manifestations of intraocular hypertension: | Acetazolamide, Timolol. |
| Medications that accelerate regenerative processes in cells: | Solcoseryl, Taurine. |
Solcoseryl is available in the form of an ointment, the drug significantly speeds up the healing process and helps to avoid pronounced scarring of the tissue. And taurine, as a substance, “slows down” the development of irreversible changes in the sections of the eyeball. , like other medicines, describes in detail the dosage and frequency of use. Carefully follow the rules for the use of any drugs!
Timolol is precisely this substance that ophthalmologists prefer when signs of high intraocular pressure appear.
What to do if there was a chemical burn of the eye after eyelash extensions?
Getting burned during eyelash extensions occurs for several reasons. This can be exposure to heat - damage of a thermal nature or chemistry (getting on the skin of the eyelids or the mucous membrane of glue).
If you have problems with eyelash extensions, you should carry out the following procedures:
- rinse eyes with a solution of potassium permanganate. Here is a link to help you understand.
- drip Taurine or any other drops into the eyeballs to reduce the inflammatory process (drugs based on human tears can be used);
- contact a doctor for help.
If the damage is localized, then an appeal to an ophthalmologist is necessary. Since only a doctor will be able to assess the seriousness of the situation and provide the patient with adequate assistance.
On the video - an eye burn after eyelash extensions:
If glue gets on the skin, then there is a possibility of developing blepharitis and other inflammatory diseases. To prevent this from happening, it is necessary to take appropriate measures and contact an ophthalmologist as soon as possible. But how to use it correctly and what is their price can be seen in this article.
You will also need to remove the extended eyelashes, since the glue irritates the skin of the eyelids and leads to an increase in unpleasant symptoms.
A chemical burn of the organs of vision is a severe injury that requires immediate treatment. You can give yourself first aid on your own, but it is advisable to take subsequent treatment under the supervision of a doctor.
15-10-2012, 06:52
Description
SYNONYMS
Chemical, thermal, radiation damage to the eyes.
ICD-10 CODE
T26.0. Thermal burn of the eyelid and periorbital region.
T26.1. Thermal burn of the cornea and conjunctival sac.
T26.2. Thermal burn leading to rupture and destruction of the eyeball.
T26.3. Thermal burns of other parts of the eye and its adnexa.
T26.4. Thermal burn of the eye and adnexa of unspecified localization.
T26.5. Chemical burn of the eyelid and periorbital region.
T26.6. Chemical burn of the cornea and conjunctival sac.
T26.7. Chemical burn leading to rupture and destruction of the eyeball.
T26.8. Chemical burn of other parts of the eye and its adnexa.
T26.9. Chemical burn of the eye and adnexa of unspecified localization.
T90.4. Sequelae of an eye injury in the periorbital region.
CLASSIFICATION
- I degree- hyperemia of various parts of the conjunctiva and the limbus zone, superficial erosion of the cornea, as well as hyperemia of the skin of the eyelids and their swelling, slight swelling.
- II degree b - ischemia and superficial necrosis of the conjunctiva with the formation of easily removable whitish scabs, clouding of the cornea due to damage to the epithelium and superficial layers of the stroma, the formation of blisters on the skin of the eyelids.
- III degree- necrosis of the conjunctiva and cornea to deep layers, but not more than half of the surface area of the eyeball. The color of the cornea is "matte" or "porcelain". Changes in ophthalmotonus are noted in the form of a short-term increase in IOP or hypotension. Perhaps the development of toxic cataracts and iridocyclitis.
- IV degree- deep lesion, necrosis of all layers of the eyelids (up to charring). Damage and necrosis of the conjunctiva and sclera with vascular ischemia on the surface of more than half of the eyeball. The cornea is "porcelain", a tissue defect over 1/3 of the surface area is possible, in some cases perforation is possible. Secondary glaucoma and severe vascular disorders - anterior and posterior uveitis.
ETIOLOGY
Conventionally, chemical (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and radiation burns are distinguished.
CLINICAL PICTURE
Common signs of eye burns:
- the progressive nature of the burn process after the cessation of exposure to the damaging agent (due to metabolic disorders in the tissues of the eye, the formation of toxic products and the occurrence of an immunological conflict due to autointoxication and autosensitization by the post-burn period);
- a tendency to recurrence of the inflammatory process in the choroid at different times after receiving a burn;
- a tendency to the formation of synechia, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.
- Stage I (up to 2 days) - the rapid development of necrobiosis of the affected tissues, excessive hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acid polysaccharides;
- Stage II (2-18 days) - manifestation of pronounced trophic disorders due to fibrinoid swelling:
- Stage III (up to 2-3 months) - trophic disorders and vascularization of the cornea due to tissue hypoxia;
- Stage IV (from several months to several years) - a period of scarring, an increase in the amount of collagen proteins due to an increase in their synthesis by corneal cells.
DIAGNOSTICS
Diagnosis is based on history and clinical presentation.
TREATMENT
Basic principles of treatment of eye burns:
- providing emergency care aimed at reducing the damaging effect of a burn agent on tissues;
- subsequent conservative and (if necessary) surgical treatment.
Washing is not carried out with a thermochemical burn if a penetrating wound is found!
Surgical interventions on the eyelids and the eyeball in the early stages are carried out only in order to preserve the organ. Vitrectomy of burned tissues, early primary (in the first hours and days) or delayed (in 2-3 weeks) blepharoplasty with a free skin flap or a skin flap on a vascular pedicle with a simultaneous transplantation of automucosa on the inner surface of the eyelids, arches and sclera are performed.
Planned surgical interventions on the eyelids and the eyeball with the consequences of thermal burns are recommended to be carried out 12-24 months after the burn injury, since allosensitization to the graft tissues occurs against the background of autosensitization of the body.
For severe burns, 1500-3000 IU of tetanus toxoid should be injected subcutaneously.
Treatment of stage I eye burns
Prolonged irrigation of the conjunctival cavity (within 15-30 minutes).
Chemical neutralizers are used in the first hours after the burn. In the future, the use of these drugs is impractical and may have a damaging effect on the burned tissue. For chemical neutralization, the following means are used:
- alkali - 2% boric acid solution, or 5% citric acid solution, or 0.1% lactic acid solution, or 0.01% acetic acid:
- acid - 2% sodium bicarbonate solution.
NSAIDs
H1 receptor blockers: chloropyramine (orally 25 mg 3 times a day after meals for 7-10 days), or loratadine (orally 10 mg 1 time per day after meals for 7-10 days), or fexofenadine (orally 120-180 mg 1 time per day after meals for 7-10 days).
Antioxidants: methylethylpyridinol (1% solution of 1 ml intramuscularly or 0.5 ml parabulbarno 1 time per day, for a course of 10-15 injections).
Analgesics: metamizole sodium (50%, 1-2 ml intramuscularly for pain) or ketorolac (1 ml for pain intramuscularly).
Preparations for instillation into the conjunctival cavity
In severe conditions and in the early postoperative period, the frequency of instillations can reach 6 times a day. As the inflammatory process decreases, the duration between instillations increases.
Antibacterial agents: ciprofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or ofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or tobramycin 0.3% ( eye drops, 1-2 drops 3-6 times a day).
Antiseptics: picloxidine 0.05% 1 drop 2-6 times a day.
Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone (eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisone (eye drops 0.5% 1-2 drops 3-6 times a day).
NSAIDs: diclofenac (orally 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (orally 25 mg 2-3 times a day after meals, course 10-14 days).
Midriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day) in combination with phenylephrine (eye drops 2 5% 2-3 times a day for 7-10 days).
Corneal regeneration stimulators: actovegin (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or solcoseryl (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or dexpanthenol (eye gel 5% for the lower eyelid 1 drop 2-3 times a day).
Surgery: sectoral conjunctivotomy, paracentesis of the cornea, necrectomy of the conjunctiva and cornea, genonoplasty, biocovering of the cornea, eyelid surgery, layered keratoplasty.
Treatment of stage II eye burns
Groups of drugs are added to the ongoing treatment, stimulating immune processes, improving the utilization of oxygen by the body and reducing tissue hypoxia.
fibrinolysis inhibitors: aprotinin 10 ml intravenously, for a course of 25 injections; instillation of the solution into the eye 3-4 times a day.
Immunomodulators: levamisole 150 mg 1 time per day for 3 days (2-3 courses with a break of 7 days).
Enzyme preparations: systemic enzymes 5 tablets 3 times a day 30 minutes before meals, drinking 150-200 ml of water, the course of treatment is 2-3 weeks.
Antioxidants: methylethylpyridinol (1% solution of 0.5 ml parabulbarno 1 time per day, for a course of 10-15 injections) or vitamin E (5% oil solution, inside 100 mg, 20-40 days).
Surgery: layered or penetrating keratoplasty.
Treatment of stage III eye burns
The following are added to the treatment described above.
Short-acting mydriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day).
Antihypertensive drugs: betaxolol (0.5% eye drops, twice daily) or timolol (0.5% eye drops, twice daily) or dorzolamide (2% eye drops, twice daily).
Surgery: keratoplasty according to emergency indications, antiglaucoma operations.
Treatment of stage IV eye burns
The following are added to the ongoing treatment.
Glucocorticoids: dexamethasone (parabulbar or under the conjunctiva, 2-4 mg, for a course of 7-10 injections) or betamethasone (2 mg betamethasone disodium phosphate + 5 mg betamethasone dipropionate) parabulbar or under the conjunctiva 1 time per week 3-4 injections. Triamcinolone 20 mg once a week 3-4 injections.
Enzyme preparations in the form of injections:
- fibrinolysin [human] (400 IU parabulbarno):
- collagenase 100 or 500 KE (the contents of the vial are dissolved in 0.5% procaine solution, 0.9% sodium chloride solution or water for injection). It is injected subconjunctivally (directly into the lesion: adhesion, scar, ST, etc. using electrophoresis, phonophoresis, and also applied to the skin. Before use, the patient's sensitivity is checked, for which 1 KE is injected under the conjunctiva of the diseased eye and observed for 48 hours. In the absence of an allergic reaction, treatment is carried out for 10 days.
Non-drug treatment
Physiotherapy, eyelid massage.
Approximate periods of incapacity for work
Depending on the severity of the lesion, they are 14-28 days. Possible disability in the event of complications, loss of vision.
Further management
Observation of an ophthalmologist at the place of residence for several months (up to 1 year). Control of ophthalmotonus, state of ST, retina. With a persistent increase in IOP and the absence of compensation on a medical regimen, antiglaucomatous surgery is possible. With the development of traumatic cataract, removal of the cloudy lens is indicated.
FORECAST
Depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the victim's admission to the hospital, the correctness of the appointment of drug therapy.
Article from the book: .
An eye burn is an emergency condition that requires immediate action. Eye burns, whether thermal or chemical, are among the most dangerous and can result in loss of vision. Corrosive substances can cause limited or diffuse damage to the cornea. The consequences of burns depend on the type and concentration of the pH solution, the duration and temperature of the substance.
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ICD-10 code
T26.4 Thermal burn of eye and adnexa, unspecified
T26.9 Chemical burn of eye and adnexa, unspecified
Causes of eye burn
Eye damage most often occurs as a result of contact with chemicals, thermal agents, various radiation, electric current.
- alkalis(slaked or quicklime, lime mortar) in contact with the eyes lead to the most serious burns, causing necrosis and destroying the structure of tissues. The conjunctiva becomes greenish and the cornea becomes porcelain white.
- acids. Acid burns are not as severe as alkali burns. The acid causes the corneal protein to coagulate, which prevents damage to the deeper structures of the eye.
- Ultraviolet radiation. An eye burn with ultraviolet light can occur after sunbathing in a solarium, or if you look at bright sunlight reflected from the surface of water or snow.
- Hot gases and liquids. The burn stage depends on the temperature and duration of exposure.
- feature electric shock burn is painless, a clear distinction between healthy and dead tissues. Severe burns provoke hemorrhages of the eyes and swelling of the retina. There is also clouding of the cornea. When exposed to electric current, both eyes are more likely to suffer.
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Eye burn by welding
During the operation of the welding machine, an electric arc is generated that emits ultraviolet radiation. This radiation can cause electrophthalmia (severe burns of the mucous membrane). The causes of occurrence are non-compliance with safety regulations, powerful ultraviolet and infrared radiation, the effect of smoke generated during welding on the eyes. Symptoms: indomitable lacrimation, acute pain, hyperemia of the eyes, swollen eyelids, pain during eyeball movements, photophobia. If electrophthalmia has occurred, it is forbidden to rub your eyes with your hands, since rubbing the pain only intensifies and leads to the spread of inflammation. It is important to immediately flush the eyes. If the retina is not damaged by the burn, then vision will be restored in one to three days.
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Risk factors
stages
Burns come in four stages. The first is the lightest, respectively, the fourth is the heaviest.
- The first degree is redness of the eyelids and conjunctiva, clouding of the cornea.
- Second degree - on the skin of the eyelids, the formation of blisters and superficial films on the conjunctiva occurs.
- Third degree - necrotic changes in the skin of the eyelids, on the conjunctiva there are deep films that are practically not removed and the clouded cornea resembles opaque glass.
- Fourth degree - necrosis of the skin, conjunctiva and sclera with deep clouding of the cornea. In place of necrotic areas, an ulcer is formed, the healing process of which ends with scars.
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Diagnosis of an eye burn
As a rule, there are no problems with the diagnosis of an eye burn. It is established on the basis of characteristic symptoms and a survey of the patient or witnesses of this event. The diagnosis should be made as soon as possible. With the help of tests and examinations: the doctor determines the factor that caused the burn and draws up a conclusion.
After the end of the acute period, in order to assess damage, it is recommended to conduct instrumental and differential diagnostics - an external examination of the eye using an eyelid lifter, measure intraocular pressure, conduct biomicroscopy to detect ulcers on the cornea, ophthalmoscopy.
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Eye burn treatment
Emergency care is aimed at determining which substance caused the burn. Remove the irritant from the eye as soon as possible. It can be removed with a tissue or cotton swab. If possible, the material is removed from the conjunctiva by everting the upper eyelid and cleaning it with a swab. Then rinse the affected eye with water or a disinfectant solution such as a 2% boric acid solution, a 3% tannin solution, or other liquids. Washing should be repeated for several minutes. To reduce the severe pain and fear that accompanies a burn, you can anesthetize the patient and give sedatives.
It is possible to use dicaine solution (0.25-0.5%) for drip anesthesia. The eye is then covered with a sterile bandage covering the entire eye, and then the patient is immediately transported to the hospital for further vision preservation. In the future, it is necessary to fight so that there is no fusion of the eyelids and destruction of the cornea.
For eyelids, it is advised to put a gauze pad soaked in antiseptic ointment, use drops of ezerin 0.03%. It is allowed to use eye drops with antibiotics:
- tobrex 0.3% (1-2 drops are instilled every hour; contraindications - intolerance to any component of the drug; can be prescribed to children from birth.),
- signicef 0.5% (1-2 drops every two hours up to eight times a day, reducing the dosage to four times a day. The duration of treatment is determined individually. Side effects are local allergic reactions.),
- drops of chloramphenicol 0.25% instill with a pipette once three times a day, one drop each)
- drops of taufon 4% (topically, in the form of instillation two or three drops 3-4 times a day. There are no contraindications and side effects),
- in severe conditions, dexamethasone is prescribed (it can be administered both topically and by injection, IM 4–20 mg three to four times a day).
Do not allow the damaged eye to dry out. To prevent this from happening, carry out abundant lubrication with petroleum jelly and xeroform ointment. Serum against tetanus is administered. For general maintenance of the body with a burn of the cornea of \u200b\u200bthe eye during the rehabilitation period, it is recommended to prescribe vitamins. They are used orally or as intramuscular or intravenous injections.
Massage and physiotherapy can be applied to improve blood circulation.
The goal of inpatient treatment is to maximize eye function. With burns of the first and second degree, the prognosis is favorable. With the latter two, surgical treatment is indicated - keratoplasty layered or through.
After the acute phase of the burn has passed, folk, homeopathic remedies and herbal treatment can be used.
Treatment of burns with folk methods
It is necessary to eat as many carrots as possible, as they contain carotene, which is good for our eyes.
Add fish oil to your diet. It consists of nitrogenous material and polyunsaturated acids that contribute to tissue repair.
With a slight burn by electric welding, you can cut a potato in half and put it on your eyes.
Herbal treatment
One tablespoon of dried clover flowers is poured with one glass of boiling water and infused for one hour. Use for external use.
Dry thyme (one spoon) is poured with one glass of boiling water. Let it brew for one hour. Apply externally.
Crushed plantain leaves in the amount of twenty grams, pour 1 cup of boiling water and leave for one hour. For outdoor use.
homeopathic remedies
- Oculoheel - the drug is used for eye irritation and conjunctivitis. Anti-inflammatory. Assigned to adults, one or two drops twice a day. There are no contraindications. Side effects are not known.
- Mucosa compositum - used for inflammatory, erosive diseases of the mucous membranes. Assign at the beginning of treatment every day, one ampoule, for three days. Side effects are not known. There are no contraindications.
- Gelseminum. Gelseminum. The active substance is made from the underground part of the plant Gelsemia evergreen. Recommended for the removal of acute stabbing pain in the eye, glaucoma. Adults take 8 granules three to five times daily.
- Aurum. Aurum. Remedy for deep lesions of organs and tissues. The recommended intake for adults is 8 granules from 3 times a day. Has no contraindications.
All traditional and non-traditional treatments in this article are for guidance only. What may be good for one person may not work for another. Therefore, do not self-medicate, visit a specialist.
Prevention
Experts say that in most cases, burns can be prevented. Preventive measures can be reduced to the simple implementation of safety regulations when working with flammable liquids, chemicals, household chemicals, and working with electrical appliances. Wear sunglasses when you are in bright sunshine. Patients who have suffered burns of the cornea of the eye are recommended to be registered with an ophthalmologist for one year after the injury.