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Ocular burns are true emergencies and represent a significant minority (7.2% to 9.9%) of ocular trauma cases.1,2 Chemical burns account for the large majority of ocular burns, with thermal burns being the second most common cause.3 Most victims are young males.2,4 The industrial workplace is the most common setting, although a significant number of cases occur in the home.4 Assaults are a significant cause of ocular burns in the lower socioeconomic groups of large cities.4,5
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Caustic agents are primarily responsible for the most severe chemical ocular burns. Most reports indicate that alkali burns are more frequent than acid burns.1,3,4 Examples of more common alkalis and acids are listed in Table 155-1.4,6–13 Ammonia causes the most serious alkali burns, while calcium hydroxide (lime) is the most common cause of alkali burns.4 Hydrofluoric acid causes the most serious acid burns, while sulfuric acid is the most common cause of acid burns.4 Fortunately, caustic agents account for only a minority of chemical ocular exposures.1 Most chemical ocular exposures are due to relatively innocuous noncaustic substances (e.g., shampoos, hair sprays, and personal defense sprays) and therefore do not cause significant or lasting damage.1,14,15
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Ocular irrigation is a simple procedure that is commonly employed in the Emergency Department. It is potentially an eye-saving procedure in the setting of significant chemical ocular burns. Physicians, nurses, and emergency medical personnel who deal with ocular emergencies should be trained in ocular irrigation. When possible, first aid personnel in the workplace should be familiar with the use of ocular irrigation.16 Most importantly, ocular irrigation must be employed rapidly.1,17 Delays in irrigation can limit its effectiveness and increase morbidity.3
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The anterior surface of the globe is the major target of toxins in ocular burns (Figure 155-1). The eyelids are the most important protective structure for the eye. The orbicularis oculi muscle is innervated by branches of the facial nerve and closes the eyelids in response to noxious stimuli. The cornea provides little in the way of protection from chemical agents. ...