Molten Aluminum Ocular Thermal Burn: A Unique Opportunity to Gauge the Impact of Thermal Energy

Abstract

Burn injuries can be subdivided into two groups: flame burns and contact burns. Ocular contact burns are more uncommon but tend to lead to more severe ocular injury. This case report describes a Roper-Hall grade 3 ocular thermal injury from molten aluminum and aims to estimate the thermal energy involved to improve future injury assessment. A 32-year-old male Myanmar migrant worker presented with a history of having molten aluminum splashed into his left eye from a workplace accident. A hardened metal cast of approximately 1.5 cm in diameter was observed buried in his inferior fornix. The severity of tissue destruction in ocular thermal injury depends on at least four factors: temperature of the agent, heat-retaining capacity of the material, duration of contact, and area over which the heat is applied. When the source is hot and has significant heat retention capacity, the result may be a severe burn with the involvement of the deeper layers of the cornea. While retrospective analyses of human ocular burns exist, these studies lack the controlled quantification of thermal energy, exposure duration, and affected area needed to establish robust correlations with clinical outcomes. Molten metal and glass ocular burns differ from other contact burns; the retained material allows for direct thermal energy calculation. This case underscores the importance of detailed reporting of the retained material in cases of ocular burns involving molten metal and glass. It could provide thermal energy estimation for the observed clinical presentation and outcome. With enough data, it may be helpful in predicting the prognosis of such cases.

Keywords: aluminum; burn injury; molten metal; ocular burn; ocular contact burn.

Figure 1. On day one, the patient presents with an aluminum cast retained in the inferior fornix

Figure 2. Minim of autologous serum

Figure 3. Day seven anterior segment photo, showing the persistent epithelial defect, stroma opacity, 1/3 limbal ischemia, and 25% bulbar conjunctiva involvement

Figure 4. Day 14: Anterior segment photos without filter (A) and with cobalt blue filter and fluorescein stain (B) showing improved corneal stromal opacity and epithelial defect

Figure 5. Day 21: Anterior segment photos showing reduced corneal opacity (A) and near-complete re-epithelialization of the corneal epithelial defect and improving bulbar conjunctival defect (B; cobalt blue filter and fluorescein stain)

Figure 6. Axial (A) and coronal (B) CT images of the head and orbits. Arrows indicate the molten aluminum cast on the left eye