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Foundations of Corneal Disease pp 109–119Cite as

Treatment of Chemical Burn to the Eye: A Changing Picture

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Abstract

Purpose: To propose a modified treatment paradigm for chemical burns to the eye – in the acute and chronic phases – in particular aiming at preventing post-burn glaucoma.

Methods: Recent laboratory and clinical data on the biology and treatment of severe chemical burns have been analyzed and organized for the cornea clinician.

Results: Corneal blindness from chemical burns can now be successfully treated with a keratoprosthesis – in immediate and intermediate terms. Long-term outcomes, however, are frequently hampered by severe glaucoma. New experimental data suggest that within hours or days after the chemical exposure, inflammatory cytokines such as TNF-α are generated in the anterior segment and diffuse rapidly posteriorly. There they can cause severe damage to the retinal ganglion cells – thus likely being a cause of glaucoma in the long term. Treatment with anti TNF-α antibody or corticosteroids within hours post-accident is markedly neuroprotective in animal models.

Conclusion: In addition to standard emergency treatment (lavage, etc.), corticosteroids (triamcinolone) should be injected sub Tenon as promptly as possible after the accident. Later, after tuberculosis clearance, inflammatory cytokine inhibitors are likely indicated until inflammation has subsided. Prophylactic IOP lowering medication (carbonic anhydrate inhibitors) is recommended, long-term. Keratoprosthesis implantation may finally be indicated in a quiet stage.

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Author Disclosures

Supported by the Boston Keratoprosthesis Research Fund, Massachusetts Eye and Ear, Boston, MA 02114.

The authors are, or have been, full-time employed by the Massachusetts Eye and Ear, the manufacturer of the Boston Keratoprosthesis.

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Authors and Affiliations

  1. Cornea Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA

    Claes H. Dohlman

  2. Centre Hospitalier de l’Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Department of Ophthalmology, Montreal, QC, Canada

    Marie-Claude Robert

  3. Division Massachusetts Eye and Ear – Harvard Medical School, Department of Ophthalmology, Boston, MA, USA

    Eleftherios I. Paschalis

Authors
  1. Claes H. Dohlman
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  2. Marie-Claude Robert
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  3. Eleftherios I. Paschalis
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Correspondence to Claes H. Dohlman .

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Editors and Affiliations

  1. Louis Block Professor Chair, Department of Ophthalmology and Visual Science, The University of Chicago Medicine & Biological Sciences, Chicago, IL, USA

    Kathryn Colby

  2. Claes H. Dohlman Professor of Ophthalmology, Harvard Medical School, Cornea & Refractive Surgery, Massachusetts Eye & Ear, Boston, MA, USA

    Reza Dana

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Dohlman, C.H., Robert, MC., Paschalis, E.I. (2020). Treatment of Chemical Burn to the Eye: A Changing Picture. In: Colby, K., Dana, R. (eds) Foundations of Corneal Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-25335-6_11

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  • DOI: https://doi.org/10.1007/978-3-030-25335-6_11

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