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Trauma
Alkali Burn

  • 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 to eye.
    • Symptoms: ocular pain, lacrimation, blepharospasm.
    • Signs:
      • In mild cases: epithelial erosion, mild corneal haze and conjunctival injection.
      • In moderate cases: cornea may opacify with slight ischemia of limbus.
      • In severe cases: significant ischemia of the sclera, avascularity of the limbus, blanching of conjunctiva and severe corneal haze.
  • Complications:
    • 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 pressure
    • Cataract and phthisis bulbi
  • Management:
    • 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 broad-spectrum antibiotics.
    • Analgesic.
    • 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 membrane
        • Conjunctival graft
        • Corneal transplantation

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