Course and outcome of accidental sodium hydroxide ocular injury.

Abstract

PURPOSE:

To evaluate the course and outcome of patients with accidental ocular alkali burns.

DESIGN:

Prospective, interventional case series.

METHODS:

Study of a cohort of 16 patients (31 eyes) who sustained concomitant accidental sodium hydroxide ocular burns and received appropriate treatment at a tertiary care eye hospital in India. The patients were followed up for 1 year, and parameters including best-corrected visual acuity, epithelial defect area, conjunctival and limbal involvement, and injury-related complications were evaluated.

RESULTS:

Severe sodium hydroxide exposure of a mean duration of 12 ± 2.5 minutes and delay in specialist eye care caused moderate to severe injury (grade II, 19% [n = 6]; grade III, 19% [n = 6]; grade IV, 10% [n = 3]; and grade VI, 52% [n = 16]). Median best-corrected visual acuity at presentation was 1.0 logarithm of the minimal angle of resolution (logMAR) units (range, 0.3 to 1.9 logMAR units), and at 1 year, it was 1.0 logMAR units (range, 0 to 1.9 logMAR units; P = .121). The median initial epithelial defect was 100 mm(2) (range, 18 to 121 mm(2)), which healed in all eyes by 3.5 months. Initial median limbal involvement was 12 clock hours (range, 3 to 12 clock hours), resulting in a residual limbal stem cell deficiency of 6 clock hours (range, 0 to 12 clock hours) at 1 year. Most common complications were glaucoma and cataract. Corneal ulcers developed in 2 eyes, and keratolimbal graft was performed in 1 patient. Grade VI injuries had significantly worse outcome than the lower-grade injuries.

CONCLUSIONS:

The course and outcome of ocular alkali burns depends on effective first aid (including a thorough eyewash), age, initial grade of injury, response to treatment, prevention of secondary infection, and control of glaucoma. Despite appropriate treatment, these eyes responded poorly and carried a guarded visual prognosis.

• Authors: Namrata Sharma, Digvijay Singh, Amit Sobti, Prakashchand Agarwal, Thirumurthy Velpandian, Jeewan S Titiyal, Supriyo Ghose
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 154 Issue 4 Pg. 740-749.e2 (Oct 2012) ISSN: 1879-1891 [Electronic] United States
• PMID: 22840487 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Sodium Hydroxide

Topics

• Accidents, Occupational
• Adolescent
• Adult
• Burns, Chemical (etiology, pathology, therapy)
• Conjunctival Diseases (chemically induced, pathology, therapy)
• Cornea (drug effects)
• Corneal Diseases (chemically induced, pathology, therapy)
• Eye Burns (chemically induced, pathology, therapy)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Sodium Hydroxide (adverse effects)
• Therapeutic Irrigation
• Treatment Outcome
• Visual Acuity (physiology)
• Wound Healing
• Young Adult