Ophthalmology/Eye Institute

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 Department of Ophthalmology Case Studies

 

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Diagnosis: Chemical (Sulfuric acid from car battery) burn to eye

Discussion:
Chemical burns to the eye are a true ocular emergency. Damage can range from minor discomfort to severe vision loss.

When a chemical burn is suspected, irrigation of the eye should begin immediately. Isotonic sterile saline is the irrigant of choice (especially if in the ER), however, water can be used if this is all that is available. Constant irrigation of at least 10-15 minutes is recommended. Irrigation should continue until the PH of the eye secretions has neutralized to around 7. Sweeping the fornix of the eye with a sterile cotton tip may help remove some retained particles. Topical anesthetics can make the irrigation more tolerable. Even with immediate and sufficient irrigation, permanent damage can still occur. Once the PH is neutralized, an eye exam can then occur. Whiting of the conjunctiva is associated with a poorer prognosis as it indicates the burn has lead to significant vascular damage.

Important initial information to ascertain includes what substance caused the injury, how long was the exposure, how long ago the exposure occurred, and how has the injury been treated prior to presentation.

Agents causing the chemical burn can be classified as either alkali, acidic or neutral. Alkali substances are lipophilic and penetrate the ocular tissues more quickly than acidic or neutral substances, leading to deeper penetration into the eye and more severe damage than an acidic agent. Common alkali substances causing ocular burns include lye (Drano), mixed cement, and ammonia (cleaning products). Acidic substances include sulfuric acid (car batteries), nail polish and vinegar. Neutral substances include substances such as pepper spray.

Risks of chemical burns to the eye include injury to most anterior portions of the eye including the lid, conjunctiva, and cornea. Damage to inner ocular structures such as the iris, ciliary body, lens and trabecular meshwork can also occur, especially with longer exposures and with alkali substances. Corneal scarring, cataracts and increased intraocular pressure (glaucoma) can occur from more severe burns.

Burns may be treated with artificial tears, topical antibiotics, topical steroids, dilating drops, and pain medication, depending on the extent of damage done. More severe injuries may require glaucoma medications to maintain a normal IOP or surgical intervention.
 

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