The ocular surface chemical burns

Abstract

Ocular chemical burns are common and serious ocular emergencies that require immediate and intensive evaluation and care. The victims of such incidents are usually young, and therefore loss of vision and disfigurement could dramatically affect their lives. The clinical course can be divided into immediate, acute, early, and late reparative phases. The degree of limbal, corneal, and conjunctival involvement at the time of injury is critically associated with prognosis. The treatment starts with simple but vision saving steps and is continued with complicated surgical procedures later in the course of the disease. The goal of treatment is to restore the normal ocular surface anatomy and function. Limbal stem cell transplantation, amniotic membrane transplantation, and ultimately keratoprosthesis may be indicated depending on the patients' needs.

Figure 1

Limbal ischemia in the inferonasal quadrant 8 days after alkali burn. Patient subsequently underwent tenonplasty and conjunctival advancement to cover the defect.

Figure 2

Patient with grade IV ocular surface burn. Note severe ischemia extending 4 mm from the cornea and corneal haze. Patient required multiple reconstructive procedures including combined conjunctival-limbal autograft and keratolimbal allograft.

Figure 3

Patient with total limbal stem cell deficiency after chemical burn who was successfully treated with conjunctival-limbal autograft (2 years after surgery).

Figure 4

Patient with total limbal stem cell deficiency after chemical burn who underwent keratolimbal allograft and penetrating keratoplasty with systemic immunosuppression (18 months after surgery).