Burns to the cornea of the eye

In almost half of the cases, patients who completely or partially lost their vision were diagnosed with a “corneal burn.”

What injuries are fatal for the cornea, how to treat burns and what measures should be taken to preserve vision? Let's figure it out.

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Epidemiology

Corneal burns account for 7-18% of eye injuries. The vast majority (84%) are chemical burns. Thermal burns account for 16% of eye burns. The average age of patients with eye burns is 36 years and they are more common in men than in women.

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Causes corneal burn

1. Injury from particles of molten metals or liquids heated to high temperatures, steam and fire (the cornea is at risk at temperatures above 45 ºC).
2. Prolonged exposure to bright light: corneal burns from ultraviolet radiation when observing solar phenomena, excessively bright sun (for example, when staying in snowy mountains or observing sea foam without protective glasses). In addition, if safety rules are not followed during welding, it is easy to get a corneal burn from welding.
3. Contact with chemicals: aggressive household chemicals, alkalis, acids, solvents.

The most dangerous burn of the cornea of the eye is an alkali burn. If acid damages only the area it hits, then alkali is more insidious: it penetrates deep into the tissue and acts more destructively.

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Pathogenesis

The characteristic features of a corneal burn include the development of a pathological process even after the elimination of the damaging agent. This occurs due to metabolic disorders in the eye tissues, the formation of toxins and the development of an immune response in the post-burn period. The vascular membrane is prone to repeated inflammation after a burn, there is a tendency to form adhesions, scars of the cornea and conjunctiva.

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Symptoms corneal burn

A person who has received a corneal burn is characterized by:

• headaches;
• unpleasant sensations from light;
• lacrimation;
• narrowing of the field of view or visual acuity;
• uncontrolled contraction of the orbicularis oculi muscles;
• pain in the eyes;
• sensation of a foreign body in the eye.

If the cornea of the eye has been burned by ultraviolet radiation, the first signs appear only after 8-10 hours.

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Stages

Burn degrees are classified depending on how severely the cornea of the eye was damaged.

• Stage I: injury to the superficial layers of the cornea. Characterized by a local increase in temperature and slight swelling of the eyelids. Examination may reveal slight dullness of the epithelium. Treatment of such an injury is done on an outpatient basis and is without consequences.
• II degree: injury to all layers of the corneal epithelium. With such a burn, erosions appear on the cornea, blisters appear on the eyelids. Timely help from a doctor will help restore vision, eliminating erosions without the formation of scars in a week or a week and a half.
• Stage III: the cornea becomes cloudy, but the pupil is clearly visible. The pattern on the cornea is almost indistinguishable. A day after the injury, folds of the decemetic membrane form. Healing occurs after 2-4 weeks, small scars remain. The cornea becomes like frosted glass, the borders of the pupil cannot be distinguished. After 3-4 weeks, a rough vascular leukoma forms on the cornea, and vision deteriorates. Sometimes the conjunctiva grows.
• IV degree: the cornea becomes cloudy-gray, traumatized to its full depth, resembles porcelain. Often the clouded lens falls out.

During a burn, the following stages are distinguished:

1. Primary and secondary cell necrosis (immediately after injury and 2-3 weeks later).
2. Fusion zone (partial restoration of the cornea).
3. Inflammatory response as a defense (lasts about 6 months).
4. Scarring and dystrophy.

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Diagnostics corneal burn

It is not difficult to diagnose a burn. However, in some cases an accurate diagnosis can only be made after some time, since only after several days can the extent of the damage and especially its depth be assessed.

In chemical burns, the cornea is almost transparent, while due to damage, the outer layers are rejected and the surviving part of the cornea becomes so thin that even minor force, closing the eyelids or a rough examination can result in perforation of the cornea. Most often, these layers of the cornea become cloudy over time, and the tissues become scarred.

When the cornea of the eye is burned by alkali, it first becomes translucent and only after a certain time does the continued action of alkaline compounds disrupt metabolic processes and lead to the development of severe clouding.

A thorough examination and assessment of the cornea, especially with a slit lamp, allows one to determine to a certain extent the degree of damage: in case of corneal burns, slightly damaged epithelium is found, which is rejected, as well as damage to other layers, endothelial pathologies, and thinning of the cornea. Instrumental diagnostics, such as ophthalmoscopy, will help to clarify the diagnosis. For example, if ophthalmoscopy reveals an increase in the temperature of the optic nerve papilla, this will indicate a greater degree of burn.

In case of minor burns, examination of the cornea with a special slit lamp allows us to determine changes that are almost impossible to detect with a regular examination. We are talking about barely noticeable erosive changes in the cornea in case of electrophthalmia or as a result of a burn with hydrogen sulfide, ammonia and similar compounds.

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Differential diagnosis

Differential diagnostics for corneal burns should separate primary changes from developing secondary changes. Consequences and complications in case of extensive damage to the conjunctiva and marginal corneal network may appear even after a week.

To establish an accurate diagnosis, it is necessary to study the anamnesis data: the type of burn, the amount and temperature of the chemical that damaged the cornea, how concentrated it was, etc.

Differential diagnostics allows you to easily distinguish a thermal burn from a chemical one. Even if for some reason the patient cannot provide this information himself, it is easy to establish by external signs.

It is much more difficult to understand by external manifestations what substance exactly burned the cornea. It is easy to determine a burn with slaked or quicklime, since particles of the substance remain on the conjunctiva. Due to the characteristic color of the substance, it is easy to determine a burn of the cornea of the eye with potassium permanganate, brilliant green, etc. Instrumental diagnostic methods will help to find out whether the burn was caused by an acid or an alkaline compound: biochemical analysis, as well as microchemical analysis of conjunctival tissue.

Treatment corneal burn

Conservative treatment is aimed at preserving vision, preventing consequences and complications that can develop both against the background of infections and as a result of the characteristics of the injury. For this purpose, the following are used:

• antiseptic ointments;
• non-hormonal anti-inflammatory and analgesic drugs;
• drugs to activate microcirculation;
• novocaine blockades;
• antioxidants;
• eye drops that restore the epithelium;
• eye drops that dilate the pupil.

On the first and second day after a corneal burn, the regeneration process is slower compared to similar mechanical injuries, since the surviving epithelium is still damaged by the burn. The doctor should apply ointment to the cornea and change the bandage every day. When bandaging, topical medications are not used, since the patient will change the bandage, and they may do it incorrectly. Drops with glucocorticoids and antiseptics will help eliminate inflammation, which lasts approximately 7 days after the end of epithelialization.

In case of severe chemical burns, extensive damage to the epithelium of the cornea, eye membranes, the development of a concomitant infection, protracted regeneration, or fusion of the conjunctiva of the eyelids with the conjunctiva of the eyeball, an ophthalmologist consultation is necessary.

Drops for corneal burns

1. To relieve swelling, you can use Visoptic, Vizin or Proculin drops. According to the instructions, they are dripped into the eye 1 drop 3 times a day. The drops will help cope with the burning sensation, relieve swelling and soothe the affected area. The maximum duration of treatment is 3 days.
2. If the corneal burn is minor but still causes discomfort, you can use Tetracaine, Alcaine or 2% Lidocaine drops. The drugs are dripped into the eye 2 times a day. They have approximately the same effect: they eliminate pain, the cornea freezes. Such drops should not be used for more than 2 days without consulting a doctor.
3. To avoid infectious complications, antibiotics for local use are used: Tobramycin, Levofloxacin, Oftaquix, Gentagut, Gentamicin and others. The course of treatment is 7 days. Drops are administered up to 5 times during the day.

In case of corneal destruction or risk of perforation, urgent surgical treatment is required: primary lamellar keratoplasty (replacing the damaged cornea or part of it with a transplant) or early penetrating keratotomy (making non-penetrating cuts on the cornea to reduce refraction along the enhanced axis). If indicated, 12-14 months after the corneal burn, optical transplantation or corneal prosthetics, eyelid plastic surgery are performed.

Non-drug treatment of corneal burns additionally includes physiotherapy and a special set of eyelid massages. It makes sense to use these methods during the recovery period, when the acute stage of inflammation is already behind us. For a speedy recovery, you should consult an ophthalmologist who will tell you what treatment will be effective given the patient's condition. Corneal burns are too specific to generalize - each case should be considered separately.

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Treatment of corneal burns - emergency homeopathy

Depending on what caused the corneal burn, the following homeopathic remedies are used:

• Causticum – for burns that do not heal well.
• Urtica urens for severe itching, swelling, and burns from poisonous plants.
• For second degree burns, apply Echinacea ointment and tincture for internal use, 3 drops every 3 hours.

Folk treatment of corneal burns

Traditional medicine methods make a significant contribution to the recovery process after a chemical or thermal burn of the cornea. They promote tissue regeneration and restoration of the eyeball.

Honey – is able to eliminate swelling, drawing off excess fluid, promotes regeneration and prevents loss of transparency of the cornea. Honey is used already when the first inflammation of the eye has passed. Honey is rich in vitamins – vitamins of group A, B, E, K, C, PP, pantothenic and folic acid – which are necessary for rapid tissue recovery

Potato compress. Raw potatoes are grated on a fine grater. Then, after first putting gauze on the eyes, apply the potatoes and leave for 15-20 minutes.

You can make a compress from tea leaves, chamomile flowers or calendula. Pour boiling water over the tea leaves (or herbs) and let it brew. This decoction can be applied to the eyes or used for rinsing.

To relieve swelling and inflammation, apply cold compresses frequently but for short periods of time – 2-3 minutes.

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Herbal treatment for corneal burns

Linden decoction compress. For the compress, pour 2 tablespoons of dried linden flowers with a glass of boiling water, let it brew and strain. Dip cosmetic disks into the decoction and place them on the eyes. It is recommended to keep the disk until it dries.

Another well-known folk remedy is aloe juice, which, like honey, contains a complex of substances that help speed up the healing process.

Calendula decoction. Dry calendula flowers are poured with boiling water and left to brew in a closed container. This decoction is used to wash the eyes. Calendula eliminates swelling, inflammation and relieves pain.

A decoction of chamomile or lungwort taken internally also promotes recovery.

Oddly enough, but diet also affects the process of restoration of eye tissue: a menu rich in vitamins A and E, fish oil will help to recover faster from a burn and improve vision.

Prevention

Preventive measures to prevent corneal burns are primarily aimed at eliminating risk factors and observing safety precautions when in contact with chemical and flammable substances. To avoid ultraviolet burns, do not forget to wear protective glasses with a light filter in clear sunny weather. If a burn does occur, the patient should periodically visit an ophthalmologist during the recovery period.

Treatment of corneal burns is a long and difficult process, which requires knowledge and experience from the doctor, and scrupulousness and strict adherence to all recommendations from the patient. Only such an approach will ensure the success of treatment.

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Forecast

The prognosis depends entirely on the type and depth of the lesion. Chemical burns rarely cause irreversible changes. The possibility of restoring vision after corneal burns with acids or alkaline compounds is determined by the depth of the lesion.

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