Current Concepts and Management of Severely Traumatized Tissues in the Inner Coatings (the Anterior Segment: Anterior Chamber Structures, the Iris, and the Lens) of the Globe: Non-mechanical Injuries

Abstract

Chemical agents that are often found in the home or workplace can cause severe ocular injuries. The proportion of ocular burns among eye injuries ranges between 7 and 18 % (Merle et al. 2008). Most (84 %) are chemical burns, while thermal burns represent 16 % of ocular burn cases. Approximately 15–20 % of facial burn cases have a secondary ocular injury. Burns are not age or gender specific, but younger age groups and males even in children appear to be more at risk (Acar et al. 2011). These groups may be more exposed to/engaged in situations/vocations with a high risk for ocular injury. Chemical injuries represent 11.5–22.1 % of all ocular traumas (Clare et al. 2012). They may occur under diverse circumstances and in various locations such as in the workplace, at home, or in school and may lead to significant loss of vision and even blindness as a result of devastating and irreversible anterior segment damages (Trudo and Rimm 2003; Schrage and Kuhn 2008). Most of the chemical injuries are limited to the superficial cornea and conjunctiva (see Chap. 3) due to the presence of a fast eyelid reflex and/or the Bell phenomenon. In addition, the injured patient usually washes his/her eyes with water by themselves or with the help of another person. In rare instances, serious injuries may have a worse prognosis, involving even unilateral or bilateral blindness. The most crucial factors in determining the visual outcome involve the contact time of the agent with the eye and the characteristics of the chemical agent such as volume, concentration, pH, and the transition rate from the cornea. Alkaline chemicals, which can penetrate the eye more easily compared to acid chemicals, can cause more damage to the iris, ciliary body, and lens.