Current status of emergency treatment of chemical eye burns in workplaces

Chemical eye burns present an avoidable, but frequent, occupational injury with potentially detrimental consequences for the quality of life and occupational rehabilitation of the injured. A periodical review of guidelines is required to assure the optimal emergency management. We reviewed the literature with emphasis on current German guidelines, primarily MEDLINE. If the crucial first-line measure, the injury prevention has failed and an eye burn has been sustained, the immediate and copious rinsing of the eye is the pivotal emergency treatment modality. Whereas the immediacy and sufficiency of the emergency rinsing are largely unanimous, there is an ongoing debate about the benefits and risks of specific rinsing solutions, and regular updates on guidelines and recommendations for the emergency treatment are warranted. The easiest and readily available rinsing solution is tap water, which fulfils the crucial criteria conveniently in most industrialized countries: purity, sterility, and neutral pH. Other rinsing solutions are proposing higher osmolality to stabilize the physiological pH, because of their superior buffering capacity. However, there is no compelling evidence for a substantial benefit, and some reports suggest that there could be unwanted side effects. In combination with the substantially increased expenditure and a more complex handling procedure, currently a general recommendation of any other solution than tap water is not warranted.

[On the new classification of eye burns]

The currently used classification of eye burns was proposed in 1973 by N.A. Puchkovskaya and V.M. Nepomnyashaya. Recent emergence of the concept of limbal stem cells of the corneal epithelium and its application in clinical practice has significantly expanded the possibilities for diagnosis, treatment, and visual rehabilitation of patients with eye burns. In 1997, Dr. Michael Wagoner proposed a classification of eye burns in which the grade of burn severity is determined by the degree of damage to the limbal stem cells. Considering this approach, the authors conducted a comparative analysis of the classifications of eye burns used in Russia (in different years) and those that have appeared in the Western countries in recent years. In this regard, a new classification of eye burns is being proposed.

Bilateral maculopathy following electrical burn: case report

CONTEXT

Electrical burns are an important etiology in dealing with patients suffering from burns. In situations of extensive deep lesions of multiple organs and systems affecting young and economically active people, there is a need for expensive multidisciplinary treatment, with a high socioeconomic cost for the community. Among the permanent injuries that explain this high cost, eye injuries stand out, since they are widely disabling. Although rare, lesions of the posterior segment of the eye are associated with higher incidence of major sequelae, and thus deserve special attention for dissemination and discussion of the few cases observed.

CASE REPORT

The authors report the case of a patient who suffered high-voltage electrical burns and presented bilateral maculopathy, which evolved with a need for a surgical approach to repair retinal detachment and permanent low visual acuity.

CONCLUSION

This report highlights the rarity of the etiology of maculopathy and the need for campaigns for prevention not only of burns in general, but also especially of electrical burns.

Orbital compartment syndrome in a burn patient without aggressive fluid resuscitation

INTRODUCTION

Orbital compartment syndrome may rarely occur in the setting of burns where therapy includes aggressive fluid resuscitation.

CASE

We report a case of bilateral orbital compartment syndrome in a 13-year-old male, with superficial facial burns secondary to hydrobromic acid, who did not receive aggressive fluid resuscitation. The patient was treated successfully with bilateral lateral canthotomy and cantholysis.

COMMENT

Facial burns may lead to orbital compartment syndrome without aggressive fluid resuscitation, likely due to excessive leakage of fluid and protein into the orbit combined with an inflammatory reaction.