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S. Ghosh, A. Kotagiri, S. Pushpoth, A. Tey, Z. Johnson, F. Figueiredo; Chemical Injuries of the Eye - Clinical Study of 98 Consecutive Cases. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5382.
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© ARVO (1962-2015); The Authors (2016-present)
To analyse the incidence, nature and prognosis of acute chemical eye injuries.
Consecutive, observational study between Apr and Oct 2009. All new patients with chemical eye injury attending the eye casualty at a tertiary referral centre in UK were included. The incidence of chemical injury presentations, patient demographics, nature of chemical, management and clinical outcomes were recorded. The severity of the injury was graded according to Roper Hall classification.
Out of the total of 11696 patients who attended the eye casualty during the study period, 98 patients (incidence 0.83%) had chemical eye injury, of which 60% were male. The mean age of the patients was 36.9±17.1 years. Five of the 7 young children (<10 years) had domestic injury from washing machine liquid. Out of the overall chemical injury patients, 52 % were work related, 42 % domestic incidents, while 6 % suffered an assault. Most of injuries were due to alkali burn (77.5%), followed by acid burn (15.30%) and unknown agent in 6 (6.1%). Eighty eight percent had unilateral injury compared with 12% bilateral. All the bilateral cases were Grade I except one who had a Grade IV injury in one eye and Grade II in the other. Eighty one percent of the patients presented on the same day of the injury, while 11% presented the next day, with the rest of the patients presenting later. Eighty eight (89.8%) were classified as Grade I, 5 (5.10%) as Grade II, 1 as Grade III and 4 (4.1%) as Grade IV. All Grade IV were due to assault with ammonia and required amniotic membrane transplant (AMT) within 2 weeks of the injury, as part of their management and despite full treatment went on to develop total limbal stem cell deficiency (LSCD).
Young male patients are more prone to have work related chemical injuries with plaster accounting for majority of them, while young children tend to have domestic injuries mainly due to washing machine liquid. Grade IV chemical injuries are often related to assault due to ammonia. Grades I, II and III chemical injuries have a very good prognosis with topical treatments while Grade IV, despite AMT progresses to total LSCD.
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