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Ascorbate for alkali burns to the eye
  1. Kevin Mackway-Jones, Consultant,
  2. Janet Marsden, Senior Lecturer
  1. Emergency Department, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether ascobate drops are useful in the management of alkalis burns to the eyes. Altogether 33 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

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    Report by Kevin Mackway-Jones,ConsultantChecked by Janet Marsden, Senior Lecturer

    Clinical scenario

    A 22 year old man has been cleaning out an old chemical drum. He attends the emergency department with severe burning in his eyes. He says the drum was marked as NaOH 20%. You arrange for copious irrigation and oral pain relief. You contact the duty ophthamologist who asks to start mydriatics, antibiotic ointement, and ascorbate drops. You do not have the ascorbate drops and wonder whether there is any evidence for their use.

    Three part question

    In [patients with alkali eye burns] do [ascorbate drops] [reduce short-term symptoms and long-term sequelae]?

    Search strategy

    Medline 1966- week 1 06/03 using the OVID interface. {[(injury.mp OR exp “wounds and injuries” OR exp burns OR burn$.mp) AND (eye$.mp OR exp eye)] OR (eye injury.mp OR eye injuries.mp OR exp eye injuries OR eye burn$.mp OR exp eye burns)} AND (alkali$.mp OR exp alkalies) AND (ascorbate$.mp OR ascorbic acid.mp OR exp ascorbic acid OR vitamin C.mp)

    Search outcome

    Altogether 33 papers were found of which one was relevant (table 2).

    Table 2

    Comment(s)

    Ascorbate (and citrate) treatment have been extensively investigated in rabbits but there are no good human data. A randomised controlled trial is mentioned as being underway in papers in 1980, but has not been reported.

    CLINICAL BOTTOM LINE

    There is no good evidence for the routine use of ascorbate in alkali burns in humans. A well designed randomised controlled trial should be performed.

    Report by Kevin Mackway-Jones,ConsultantChecked by Janet Marsden, Senior Lecturer

    References

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