Abstract
Purpose :
To describe the clinical outcomes, management and socio-economical consequences of severe ocular chemical burns that required admission to a tertiary hospital
Methods :
Retrospective review of all consecutive cases with severe ocular chemical injuries that were admitted to the Royal Victoria Infirmary eye ward between April 2013 and September 2015. Thirty-seven patients were included; demographics, visual acuity, type of injury, rate of limbal stem cell deficiency (LSCD), management and socio-economic data were evaluated
Results :
Mean age on admission was 34.5 years (median 29; range 16-82; SD 16.1); 30 male (81.1%) and 19 bilateral cases (51.4%). Causative agent: alkali in 30 cases (81.1%), acid in 3 cases (8.1%), and unknown in 4 cases (10.8%). Fifteen cases (40.5%) were assaults, 11 (29.7%) were accidents at work, 9 (24.3%) were domestic accidents and 3 (8.1%) were undetermined. Eleven patients (29.7%) were unemployed (10 assaults, 1 domestic), 19 (51.4%) were laborers (11 work-related, 4 domestic, 3 assaults, 1 unknown), 4 (10.8%) were students (2 domestic, 1 work-related, 1 assault), and 3 (8.1%) were retired (2 domestic, 1 assault). Mean admission time was 4.3 days (median 3.5; SD 3.1; range 0-12). Mean follow-up time was 128.5 days (median 30; SD 223.6; range 1-796). Mean cost of admission was 2,478£ (median 2,125£; SD 1,496.9£; range 274-5,785£). Fifteen patients (40.5%) were lost to follow-up (8 assaults), 10 (27.1%) are returning, and 12 patients (32.4%) were discharged after being reviewed in clinic after discharge from the ward. These were mild chemical injuries that were admitted inadequately, probably after an initial incorrect assessment, with the consequent waste of resources. Five patients (7 eyes) (13.5%) developed total or partial LSCD, all being assaults (4 returning, 1 lost to follow-up).
Conclusions :
Main causative agent herein was alkali, with men in the working age being most frequently involved. Many patients required prolonged hospital admission and lengthy follow-up. The majority of cases were assaults, closely followed by work accidents. A high proportion of assaults occurred in unemployed patients, with the majority being lost to follow-up. All the LSCD cases were assaults. We believe that the socio-economic environment plays an important role in the severity and the compliance to follow-up and treatment
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.