Rising incidence of ocular chemical injury secondary to assault in the Northeast of England

Abstract

Purpose : To report the rising incidence of ocular chemical assaults and analyse the epidemiologic and clinical profile of these injuries at a tertiary eye centre in the Northeast (NE) of England. These acts of violence affect the victims physically, psychologically and impact their quality of life negatively. Hence, constitute a significant social concern

Methods : Retrospective review of all consecutive cases with ocular injuries secondary to chemical assault presenting to the Eye Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK between November 2015 and October 2020. The incidence, patient demographics, nature of chemicals, severity, management and clinical outcomes were recorded

Results : During the study period, 126 eyes of 90 patients endured these injuries secondary to an assault. Number of chemical assaults was 7 (9 eyes), 22 (31 eyes), 23 (30 eyes), 15 (21 eyes) and 23 (35 eyes) in the 1^st, 2^nd, 3^rd, 4^th and 5^th year respectively. The mean age was 32.3 years (SD 11.7; Range 13-78). Male (92.2%) preponderance was noted. The ocular injury was unilateral in 54 patients (60.0%) and bilateral in 36 (40.0%). Ammonia was the commonest chemical used (67.8 %). Roper Hall severity grading at presentation was grade 1 in 61.9% (n= 78), Grade 2 in 12.7% (n=16), grade 3 in 12.7% (n=16), grade 4 in 7.9% (n= 10) and undocumented in 4.8% (n=6). Out of the 90 eyes, 82 (91.1%) were acutely managed medically. Eight eyes (8.9 %) needed amniotic membrane transplant, 7 of which were Roper Hall Grade IV and 1 was Grade III. Five of these patients progressed to total limbal stem cell failure despite maximal medical and surgical management

Conclusions : A rise in incidence of eye injuries caused by chemical assault, also known as “acid attack”, has been observed in young adult men over the past 5 years in NE of England. This can be vision threatening and is a rather serious medical and social concern requiring further investigation to be able to increase public awareness, implement stricter regulations, better surveillance and means of prevention and provide adequate support to the victims

This is a 2021 ARVO Annual Meeting abstract.

 

Fig 1: Incidence of chemical assault related ocular injury: Nov 2015 - Oct 2020

 

Fig 2: A. Slit-lamp image acute chemical injury; B. Corresponding corneal/conjunctival staining; C. Total limbal stem cell failure; D. Post limbal stem cell transplant & penetrating keratoplasty.