Acute ocular chemical burn injury grade and limbal stem-cell deficiency (LSCD) are associated, according to research published in Eye & Contact Lens. This association highlights burn severity as one of the most important factors related to prognostic outcomes among patients with ocular chemical burns.

Researchers retroscopically analyzed 137 eyes of 104 patients (mean age 42.69±17.39 years, 86 men) with acute ocular surface burns presenting to a tertiary care center between 2010 and 2020. Treatment included fluorometholone acetate drops, artificial tears, moxifloxacin drops, topical 1% cyclopentolate, ascorbic acid, and doxycycline for all patients. Clinicians performed amniotic membrane transplantation (AMT) when corneal epithelial defects persisted beyond 2 weeks.

The team determined that the primary causes of these injuries were home accidents (32.6%) and industrial accidents (45.1%). Causative agents were most frequently alkaline (49.0%), followed by acids (35.5%), and neutral substances (5.7%). Patients presented for examination a mean 14.72±18.8 hours after injury.


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Investigators noted that injuries were most frequently grade 6 (18.2%), followed by grade 5 (17.5%), and grade 4 (16.7%). Complications mostly occurred in eyes with grade 2 injury or higher (83.7%). Complications included LSCD (44.5%), symblepharon (15.3%), secondary glaucoma (12.4%), secondary cataract (3.6%), and corneal scarring or melting (6.5%). 

A total of 46 eyes required surgery for complications which mostly involved limbal stem-cell transplantation (LSCT) (39.1%) or amniotic membrane transplantation (34.8%). The team noted that LSCD rate was 44.52% across chemical burn grades, particularly in grades 5 (24.6%) and 6 (39.3%), and injury grade and LSCD were associated (P <.001).

“[T]he most important prognostic factor for these cases is the severity of the burn,” according to the researchers. “Low-grade burns at presentation tend to have a good prognosis with medical treatment. However, complication formation and surgical intervention requirement rates are significant in high-grade burns. Therefore, it is important to determine the spreading of the regional injury severity beside the global one to predict complication risk of the injuries.”

Study limitations include a retroscopic nature, single center design, and the inability to obtain scleral ischemia data and the exact time of reepithelialization.

Reference

Akgun Z, Palamar M, Egrilmez S, Yagci A, Selver OB. Clinical characteristics and severity distribution of tertiary eye center attendance by ocular chemical injury patients. Eye Contact Lens. 2022;48(7):295-299. doi:10.1097/ICL.0000000000000908