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Treatment of Chemical Burn to the Eye: A Changing Picture

  • Claes H. DohlmanEmail author
  • Marie-Claude Robert
  • Eleftherios I. Paschalis
Chapter

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.

Keywords

Chemical eye burn Corneal ulceration Glaucoma Inflammatory cytokines Infliximab Keratoprosthesis 

Notes

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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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Claes H. Dohlman
    • 1
    Email author
  • Marie-Claude Robert
    • 2
  • Eleftherios I. Paschalis
    • 3
  1. 1.Cornea Department of Ophthalmology, Harvard Medical SchoolMassachusetts Eye and EarBostonUSA
  2. 2.Centre Hospitalier de l’Université de Montréal, Centre Hospitalier Universitaire Sainte-JustineDepartment of OphthalmologyMontrealCanada
  3. 3.Division Massachusetts Eye and Ear – Harvard Medical SchoolDepartment of OphthalmologyBostonUSA

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