Deleepkumar Kozhikkot Velayudhan, Preetha Francis, Raju Kuzhuppilly Vallon, Rini Raveendran
BACKGROUND Chemical injuries to the eye is one of the true ophthalmic emergencies. Alkali injuries are more common. Immediate and prolonged irrigation followed by aggressive early management and close monitoring is essential to promote ocular surface healing and provide the best opportunity for visual rehabilitation. The major pathophysiology during chemical ocular burns causes damage to the eyelids, conjunctiva, cornea, and the anterior segment of the eye. At these locations, the damage has the potential to cause permanent visual impairment based on the volume, pH, duration of exposure, and degree of penetration of the chemical offender. The severity of injury is related to the duration of exposure, degree of penetration of chemical and the time gap between exposure and presentation to the hospital. Acids usually causes superficial damage and opacification of cornea and those with alkalis tend to present with a damage to deeper ocular structures. First treatment can form the final deciding factor for visual outcome. Chemical ocular injuries encompass a wide spectrum. There is dearth of information in injuries caused by chemical agents in Kerala, and being a tertiary care centre, Calicut Medical College which was the major source of medical care for the people from low socioeconomic, our proper intervention is the need of hour. MATERIALS AND METHODS The relationship between visual impairment and clinical characteristics was analysed using semi structured objective questionnaire, techniques to measure visual acuity and intra ocular pressure, slit lamp examination to investigate limbal ischemia and main visual outcome measured by regular follow up on first week, first month, and third month by looking at limbal ischemia, symblepharon, corneal haze, vascularisation, look for signs of uveitis, lens opacity, visual acuity, IOP. RESULTS The commonest age group to be involved was above 19 years. Maximum number of patients in the present study were males. Most of the injuries are accidental and was at workplace. Most common cause of chemical injury was found to be due to alkali 35 (70%). Steroids are given to the patients who had anterior chamber reaction and severe chemical injury which responded well. Early management showed good results. CONCLUSION In the present study, most common age group to be involved in chemical eye injuries was 19-56 yrs. (86%) and most patients were males. 72% of chemical injuries were occupational and due to alkali. Most of the chemical injuries were unilateral and had grade 1 chemical injury. 88% of chemical injuries were reported within 24 hrs. Topical steroids when instilled in the acute phase, inspite of an epithelial defect, showed better healing and there were no case of corneal melting. Most common complications were symblepharon, corneal vascularization and leucomatous corneal opacity.
