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Shawn S. Barnes, William Wong, Jr., John C. Affeldt; Severe Airbag Related Ocular Alkali Injury. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1990. doi: https://doi.org/.
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The instantaneous (50msec) inflation of motor vehicle accident (MVA) triggered airbags is achieved through the explosive ignition of sodium azide. Reaction byproducts include powdered metallic oxides, sodium bicarbonate and the potent alkali sodium hydroxide (lye). This occasionally released alkali is responsible for ~20% of all airbag related eye injuries, with the majority manifested as rapidly healing corneal abrasions or mild anterior segment alkali burns. We report for the first time a severe (Pfister-Koski classification scheme) bilateral airbag related ocular alkali injury.
Interventional case report
A 47 yo male with no previous ocular history was involved in a rural setting MVA, sustaining multiple life-threating injuries. Transport logistics and prioritized injury care resulted in no ocular lavage until 7 hours post injury. Initial eye exam revealed a VA of LP OU, opaque de-epithelialized corneas OU, diffuse limbal opacification OU, and retained chemical particulates. Six months after injury, BCVA was 20/200 OD and 20/80 OS. Slit-lamp exam revealed diffusely scarred and vascularized corneas OU, with symblepharon OD and inferior sulcus contraction OS. The patient is currently awaiting bilateral limbal stem cell and corneal transplantation.
As demonstrated in this case, airbags despite their life saving intent can also be associated with serious ocular injuries including severe alkali burns. This case emphasises the importance of ER guide lined immediate ocular lavage following all airbag deployment MVA's, and also suggests the addition of particulate clearing forniceal sweeps to those
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