- Alkaline compounds cause saponification of the fatty acids in cell
membranes, which penetrates the ocular surface epithelium as well
as deeper cellular structures.
- Corneal and conjunctival epithelium, goblet cells, stromal keratocytes,
corneal extracellular matrix, blood vessels, ciliary body and trabecular
meshwork may be damaged.
- Clinical features:
- Immediate rise in the pH following alkaline solution exposure
- Symptoms: ocular pain, lacrimation, blepharospasm.
- In mild cases: epithelial erosion, mild corneal haze and
- In moderate cases: cornea may opacify with slight ischemia
- In severe cases: significant ischemia of the sclera, avascularity
of the limbus, blanching of conjunctiva and severe corneal
- Eyelid scarring
- Corneal opacification, severe dry eye, corneal ulcer, perforation
with potential secondary intraocular infection
- Conjunctival scarring, symblepharon or ankyloblepharon
- Aqueous dynamic changes with increased or decreased intraocular
- Cataract and phthisis bulbi
- Immediate irrigation of eye until the pH of the cul-de-sac has
returned to neutrality. (pH= 7.0)
- Remove foreign bodies and sweep fornices.
- Cycloplegic drops.
- Topical prophylactic
- Topical steroid for I week to decrease the inflammatory response.
- Control of intraocular pressure.
- Insertion of methymethacrylate ring into cul-de-sac might prevent
symblepharon and conjunctival fibrosis.
- Consider doxycycline for its collagenase inhibitor effect.
- Vitamin C 2 gram qid to promote collagen synthesis.
- During re-epithelialization phase:
- Intense lubrication with preservative free tear is essential
- Soft contact lens maybe helpful
- Patching or temporary tarsorraphy
- Surgical treatment:
- Limbal stem cell transplantation with or without amnioniotic
- Conjunctival graft
- Corneal transplantation