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Case Analysis: Chemical Burns

Terms in this set (11)

Which type of chemical burn i more vision threatening: Alkaline or Acidic?
Alkaline
All of the following are alkaline chemicals except:

a) Bleach (calcium hypochlorite)
b) Cement paste
c) Airbag residue
d) Vinegar
e) Lyse (Sodium hydroxide)
a) Vinegar
Chemical Injury: Can occur via solid, liquid, poweder, mist or vapor.

Home: _______, disinfectants, solvents, ______, drain cleaners, oven cleaners, ammonia, and bleach

Agricultural: _______ and _____

Workplace: Plaster and cement

Assult: Lye and _____
a) Detergents, cosmetics
b) Fertilizers and pesticides
c) Mace
Chemical Injury:

The following are all _____: liquid drain cleaner, lye, oven cleaner, bleach, lime, ammonia, borax, plasters and airbag powder.

The following are all ______: battery/sulfuric acid and vinegar.

For more chemical information contact who?
A) Alkali
b) Acidic
c) Position control center
Acute Signs of Chemical Injury:
a) _____ _______ defects (SPK - sloughing of the entire epithelium)

b) Corneal _____ and _____

c) Perilimbal ______ (blanching of conjunctival/episcleral vessels)

d) Conjunctival ____, hyperemia, hemorrhages

e) Periocular ______ edema/burns

f) AC Reaction. What type of IOP?
a) Corneal Epithelial
b) Edema, opacification
c) Inschemia
d) Chemosis
e) Lid
f) Elevated IOP
Hugh's Classification of Alkali Burns:

a) Grade 1: ______ alteration without limbal _____

b) Grade 2: Corneal _____ defect with mild _____ haze but ____ still visible; ischemia of less than _____ of limbal circumference

c) Grade 3: _____ corneal epithelial defect with ______ haze obscuring the iris; ischemia of ____ to ______ of limbal circumference.

d) Grade 4: ______ cornea obscuring view of iris or pupil. Ischemia greater than ______ the limbal circumference
a) Epithelial, ischemia
b) Epithelial, stromal, iris, 1/3
c) Total, stromal, 1/3-1/2
d) Opaque, >1/2
Late Signs and Complications of Alkaline Burns:

a) ______ and _____ of cornea
b) _________
c) Cataract formation
d) Secondary glaucoma
e) Corneal thinning and perforation
f) _____ ______
a) Conjunctivalization, vascularization
b) Symblepharon
c) Phthisis bulbi
Emergency Tx:

1) Immediate _____ with ___/balanced ____/____ _____ solution. Should be initiate at the site of injury and continued till evaluation. Topical Anesthesia and lid speculum. __-__ liters for ___ minutes at least. May irrigate by hand or use Morgan Lens. Evert and irrigate under lens. Check _____ with litmus paper. Continue until pH of conj. sac neutralizes. May need to irrigate nasal lacrimal drainage system/sinus.

2) Remove ____ matter (double lid eversion)

e) ______ devitalized corneal epithelium and necrotic tissue

f) ______ patient for pain

g) Control ______ if necessary (best controlled via what medications to stop toxicity from topical glaucoma medications?)
Irrigation
Water/Saline/Ringer Lactate
2-10, 30
pH
Particulate
Debride
Cycloplegia
IOP, PO CAIs
Following 1-2 Weeks:

a) ____ (PF) with topical ______ (continue until all epi is intact)

b) _____ patient for pain and use IOP lowering meds if necessary

c) ______ of conjunctival adhesions (use a moistened cotton-tipped applicator to sweep fornices).

d) ____ ______ 1% QID to q 2 hrs 7-10 days with rapid taper thereafter (only severe bruns)

e) _______ 50-100 mg PO bid

f) Topical Ascorbate 10% q1h

g) ____ ___ if normal renal function (to promote collagen synthesis).
a) Lubrication, AB
b) Cycloplegia
c) Lysis
d) Prednisolone acetate
e) Doxycycline, Vitamin C
Other Considerations: _____ CL. Pressure patch. Lateral tarsorrhaphy. Botox-induced __. Oral pain medications. Punctal occlusion. Amniotic Membrane graft (ProKera)
Bandage
Ptosis
Chronic Management: ____ _____ ___ transplant. Corneal transplant is often delayed for years after, ______ in host bed is associated with higher risk of injection.
Limbal Stem Cell Transplant
Vascularization
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