Ocular chemical burns. Case report.

Abstract

Background. Ocular burns represent about 11-22% of ocular trauma. The most affected are young men, 20-40 y. o. These can happen anywhere, at home, work or after physical aggression. The most severe damage is due to acids and alkali. They can destroy limbal stemcells and produce recurrent epithelial ulcerations, chronic stromal ulcers, deep stromal vascularization and corneal perforation, in this way leading to blindness. Acid ocular burns are produced by: sulfuric acid (battery acid, industrial cleaner), acetic acid (vinegar), hydrochloric acid (chemical laboratories), sulfurous acid (bleach, refrigerant, fruit and vegetable preservative). Alkali burns: ammonia (fertilizers, refrigerants), lye (drain cleaner), lime (plastic, mortar, cement, whitewash), potassium hydroxide (caustic potash), magnesium hydroxide (sparklers, incendiary devices). In our case, patient’s burn was due to salicylic acid (a component used for preparing drops to treat dermatomycosis). Case report. A 42 y.o. male presented to our clinic with right eye pain, redness and decrease of visual acuity for two weeks, when he accidentally instilled a drop of topical dermatomycosis medication (wich contains salicylic acid of 10%, ethanol 3%, phenol 1% and preservatives) considering it as artificial tears. That led to severe ocular pain, irritation, watering and photophobia. Clinical examination revealed: VA OD/OS = 0,01/0,67; at slit lamp biomicroscopy - diffuse conjunctival congestion with corneal epithelial defect of 6 × 5.7 mm involving the central visual axis with swollen rounded edges and surrounding area of corneal edema. After saline wash, the patient started on topical moxifloxacin 0.5%, dexamethasone 0.1%, vitamin C drops, hydroxy propyl methyl cellulose 0.3%, and carboxymethylcellulose gel 1% along with oral doxycycline 100 mg and vitamin C 500 mg., subconjunctival autologous serum and 2 amniotic membrane transplantation were performed. The defect healed leaving behind a macular corneal opacity after a period of 10 weeks, VA OD= 0,16. Conclusions. 1. Salicylic acid and phenol are frequently used for most dermatological drugs. They affect the ocular surface, causing chemical burns. 2. The release of dermatological drugs similar to ophthalmic solutions in vials is a risk factor for confusing them, especially if the patient has visual impairment, is mentally deficient, or simply is in a hurry. 3. The treatment of chemical burns is very challenging and often ends with blindness.