Burns to the Eye
Burns to the eye can occur after heat- or chemical-related
injuries and can result in serious complications, including permanent
blindness.
The eyelids close quickly in a reflex reaction to protect
the eyes from harm. However, irritating or harmful chemicals still sometimes
get onto the surface of the eye, causing chemical burns.
The most dangerous chemical burns involve strong acids or
alkali. Alkali burns tend to be more serious than acid burns. Alkali substances
include lye and are most commonly found in lime products, concrete, plaster and
mortar, oven and drain cleaners, dishwasher detergent, and fertilizers. Burns
may involve liquids, which splash, or, less commonly, powdered material, which
can blow into the eyes.
Severe chemical burns of the transparent dome on the front
surface of the eye (cornea), especially alkali injuries, can lead to scarring,
perforation of the eye, infection, and blindness.
Chemical burns to the eye are very painful. Because the pain
is so great, a person tends to keep the eyelids closed. Closed eyelids keep the
substance against the eye for a prolonged period, which may worsen the damage.
The blink reflex usually causes the eye to close in response
to heat. Thus, thermal burns tend to affect the eyelid rather than the
conjunctiva or cornea. Thermal burns of the conjunctiva or cornea are usually
mild and may cause no lasting damage to the eye.
Wearing safety glasses or a face shield when handling
potentially hazardous materials is essential to help prevent burns.
Treatment of Burns to the Eye
Immediate flushing of the eye with water
Continued flushing of the eye with saline by medical
personnel
Chemical burns
A chemical burn of the eye is treated immediately, even
before medical personnel arrive. The eye is opened and flushed (irrigated) with
water or saline. When burns are caused by strong acids or alkali or other
severely caustic substances, the eye should be irrigated continuously for at
least 30 minutes or until the pH (a measure of the acidity or alkalinity) of
the eye is normal. Irrigation can be continued where it began, in an ambulance,
or in an emergency department. Because pain may make it difficult for the
person to keep the injured eye open, another person may have to hold the eyelid
open while the eye is irrigated.
A doctor or other health care practitioner can instill an
anesthetic drop in the eye to make it much easier to keep the injured eye open.
In an emergency department, doctors often use special irrigating devices.
Did You Know...
A chemical burn of the eye should be flushed with water
immediately, and flushing should continue at least until medical personnel
arrive.
After irrigation, the doctor examines the surface of the eye
and the inside of the eyelid and removes any substance still embedded in the
tissue. The inside of the eyelid is also swabbed to remove any tiny particles
that may not be visible.
A doctor may instill a drop of a drug that dilates the
pupil, relaxing the muscles of the colored part of the eye (iris) and
preventing them from having painful spasms. Topical antibiotics (drops or
ointment) are used to lubricate the eye and prevent infection. Corticosteroid
drops (such as prednisolone) may also be given by an ophthalmologist for a
limited period of time.
Although anesthetic eye drops relieve pain, they may also
slow healing and are usually not given after the initial irrigation. Pain can
be treated with acetaminophen or, if severe, acetaminophen with oxycodone. If
the cornea is burned, an antibiotic ointment is put in the eye.
Severe burns need to be treated by an ophthalmologist (a
medical doctor who specializes in the evaluation and treatment—surgical and
nonsurgical—of eye disorders) within 24 hours to preserve vision and prevent
serious complications, such as damage to the cornea and iris, perforation of
the eye, and deformities of the eyelid.
In more severe burns, other topical and/or oral drugs such
as vitamin C may also be used. Severe burns require frequent eye examinations.
Some chemical burns are so severe that surgery is required and even with the
best treatment the eye can become blind or visually impaired.
Thermal burns
Eyelid burns are treated like other skin burns. Doctors
clean eyelid burns and then apply an eye antibiotic to prevent infection. Burns
of the conjunctiva or cornea may be painful, so people may need to take
analgesics. Doctors may also give cycloplegic eye drops to prevent painful spasm of the muscles that
constrict the pupil, as well as an antibiotic eye ointment to prevent
infection.
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