Elsevier

Ophthalmology

Volume 107, Issue 10, October 2000, Pages 1829-1835
Ophthalmology

Management of alkali burns: An 11-year retrospective review

https://doi.org/10.1016/S0161-6420(00)00289-XGet rights and content

Abstract

Objective

To review the spectrum of patients with alkali burns admitted over an 11-year period and to assess the clinical outcomes after the introduction of a standard alkali burn treatment protocol.

Design

Retrospective nonrandomized comparative study.

Patients and interventions

A total of 121 patient records with alkali burns (n = 177 eyes) admitted to a tertiary hospital between 1987 and 1998 were reviewed. Eyes treated with a standard alkali burn treatment protocol, which included intensive topical steroids, ascorbate, citrate, and antibiotics, were compared with eyes treated by conservative management with antibiotics, and a short course of steroids.

Main outcome measures

Time to corneal reepithelialization, final best-corrected visual acuity, and time to visual recovery, length of hospital stay, and complications were analyzed.

Results

The standard protocol tended to delay corneal reepithelialization by one day (P = not significant) in eyes with grade 1 burns (n = 76) and by 2 days (P = 0.04) in grade 2 burns (n = 52), with no difference in final visual outcome. There were 37 eyes with grade 3 burns. Those treated with the standard protocol showed a trend toward more rapid corneal reepithelialization. Twenty-seven of 29 (93%) eyes with grade 3 injuries achieved a final best-corrected visual acuity of 20/40 or better compared with 3 of 6 (50%) eyes not treated according to the standard protocol (P = 0.02). Eyes with grade 4 burns (n = 12), whether treated with the standard protocol or not, required 10 to 12 weeks for corneal reepithelialization. There was no statistically significant difference in final visual acuity.

Conclusions

On the basis of our findings, a number of recommendations can be made for the management of alkali injuries. Patients with a grade 1 or 2 injury do not require routine admission and do not benefit from the use of intensive treatment with ascorbate and citrate. A trend toward more rapid healing and a better final visual outcome were apparent in grade 3 burns, but our standard protocol made no difference in grade 4 burns.

Section snippets

Patients

The RVEEH is a tertiary care ophthalmic hospital serving the state of Victoria, Tasmania, and parts of southern New South Wales, Australia. It has a referral base of approximately 5 million people. More than 20,000 ophthalmic emergencies are assessed each year. A computer search of the medical records for all patients admitted with the diagnosis of alkali, acid, or other burn of the cornea and conjunctival sac, eye, or adnexa (ICD-9-CM diagnostic codes 940.0-9) was performed for the period of

Methods

All patients included in the study were assessed at the RVEEH and had their treatment initiated within 24 hours of injury, although emergency irrigation was usually initiated before referral to the study hospital. All patients received copious irrigation of their injured eye(s) until the pH was documented as neutral and for a minimum of 30 minutes. Criteria for admission included: (1) a grade 2 injury or worse in one eye or (2) a grade 1 injury in a child, mentally handicapped individual, or a

Demographics and nature of injury

The study period was from January 1, 1987, until January 31, 1998. There were 121 patients admitted to the RVEEH with alkali burns (177 eyes). The patient demographics and nature of injury are summarized in Table 2. The number of patients with alkali burns admitted by year varied over the decade from a low of 5 to a high of 31 (Fig 1). Data for the state of Victoria for this period show that 82 of 129 (64%) patients treated in public hospitals for injuries coded as alkali burns were treated at

Discussion

This study describes the spectrum of ocular alkali injuries treated at a large referral hospital and assesses the risks and benefits of adjunctive medical therapy. The study includes most of the serious alkali burns treated in the state of Victoria because the RVEEH treated 64% of all inpatients statewide. Although our review of inpatient records revealed a number of incorrectly categorized burns, our impression is that this series is representative of ocular alkali injuries in Victoria.

The

References (34)

  • P Wright

    The chemically injured eye

    Trans Ophthalmol Soc UK

    (1982)
  • W.M Grant

    Experimental investigation of paracentesis in the treatment of ocular ammonia burns

    Arch Ophthalmol

    (1950)
  • R.R Pfister et al.

    Effect of synthetic metalloproteinase inhibitor or citrate on neutrophil chemotaxis and the respiratory burst

    Invest Ophthalmol Vis Sci

    (1997)
  • R.R Pfister et al.

    The combined effect of citrate/ascorbate treatment in alkali-injured rabbit eyes

    Cornea

    (1991)
  • R.R Pfister et al.

    The efficacy of sodium citrate in the treatment of severe alkali burns of the eye is influenced by the route of administration

    Cornea

    (1982)
  • J.L Haddox et al.

    An excess of topical calcium and magnesium reverses the therapeutic effect of citrate on the development of corneal ulcers after alkali injury

    Cornea

    (1996)
  • R Klein et al.

    Ocular alkali burns in a large urban area

    Ann Ophthalmol

    (1976)
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    Supported by an R. Samuel McLaughlin Foundation Fellowship (SCB), Department of Ophthalmology, Queen’s University, Kingston, Ontario, Canada.

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