Abstract
Purpose :
Ocular chemical burns secondary to assault have increased significantly in the UK over the last 2.5 years. The aim of this project is to investigate these injuries at a tertiary eye centre in the UK.
Methods :
Retrospective review of all consecutive cases with ocular injuries secondary to chemical assault presenting to the Royal Victoria Infirmary, Newcastle upon Tyne between October 2015 and May 2018. The incidence, patient demographics, nature of chemicals, severity (using Roper Hall classification), management and clinical outcomes were recorded.
Results :
Of the total 570 patients presenting to our eye casualty with ocular chemical injuries during the study period, 37 patients (52 eyes) endured these injuries secondary to an assault (incidence: 6.49%). The mean age was 30.9 years (SD 10.3; range 16-60) with male preponderance (94.6%). Mean time to presentation from assault was 4 hours (SD 4.8 hours; range 0.33 to 18.7 hours). The ocular injury was unilateral in 22 patients (59.4%) and bilateral in 15 (40.5%). The most common chemical used was ammonia, in 21 patients (56.7%) followed by unknown in 15 (40.5 %) and acid in 1 (2.7%). According to Roper Hall classification, 37 eyes (69.2%) were grade 1; 5 (9.6%) were grade 2; 6 (11.5%) were grade 3 and 4 (7.6%) were grade 4. Out of these patients 24 (64.8%) did not need admission, 2 (5.4%) refused and 11 (29.7%) were admitted for intensive management. 4 eyes (7.6%) required amniotic membrane transplant. The incidence increased over the study period with 6 assaults in the 1st 12 months (Oct 2015-Sep 2016); followed by 18 (200% increase) for the 2nd 12-month period (Oct 2016-Sep 2017); and 13 in the 1st 6 months of the 3rd period (Oct 2017-Apr 2018) with the potential increase of 333% for the full 12 months compared to year 1. Despite intensive medical management and amniotic membrane transplant, 3 (5.7%) eyes progressed to total LSCD.
Conclusions :
Ocular chemical burn represents an ocular emergency with potentially serious vision threatening consequences. Causing injury to the eyes with chemicals is a mode of assault to which young adult males are more susceptible. The incidence of these assaults is on rise over the past 2.5 years in the UK, likely in relation to an important social problem requiring further investigation. Ammonia is the most common chemical used. Grades 1-2 have good prognosis whereas grade 3-4 can progress to total LSCD despite maximum treatment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.