Acute Ocular Burns

Drs Swapna Shanbhag, Anahita Kate and others report on a large, tertiary-level study describing the clinical profile of acute ocular burns in adults and children. They note that men are at far higher risk of acute burns, while children have a higher chance of severe injury and poorer outcomes. Alkalis, primarily chuna (slaked lime), was a key cause of burns. 

Chemical burns are a key cause of injury to the eye, especially in low- and middle-income countries. Studies have noted an ocular burns prevalence of under 5% in developing countries, most of which are avoidable or preventable. The intensity of the burn depends on the area exposed and the depth of the injury. The thermal and chemical properties of the agent and its interaction with the ocular surface also matter. So, the extent of damage (graded and classified using a system called the ‘Dua grading system’) to features like the limbus and conjunctiva is a good indicator of the prognosis and outcome. Ocular burns can be caused by both alkalis and acids and can result in vision loss, blindness, and in some cases, even loss of the eye. 

Children and young adults are at a greater risk of ocular chemical burns. Both the home and the workplace are sites of potential injury. Children with unsupervised access to household chemicals, or adults working with chemical agents without adequate protection are at risk of injuring their eyes. Many cultural and social practices impact our access and handling of chemicals. South and Southeast Asia, for example, have a long history of paan (betel leaf) consumption where powdered, edible lime is mixed with water (slaked lime or chuna) and used as a binding agent. Quick lime is also used to whitewash walls, where the adult applying the whitewash does not wear protective eyeglasses while handling the agent. While these are common practices, there is little evidence on the causes, severity, and treatment outcomes of ocular burns among children and working-age adults in India. 

In a new paper in the Indian Journal of Ophthalmology, Drs Swapna Shanbhag, Anahita Kate, and others from LVPEI and Dr Sharon D’Souza from the Narayana Nethralaya address this gap in knowledge with a large, hospital-based study on acute ocular burns. This retrospective study analyzed data from 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to the two tertiary level centres for acute ocular burns (AOB) treatment. AOB accounted for 5-7% of all emergency cases seen at these centres over the four-year study period. 81% of adult patients and 64% of children were male. 

Alkalis accounted for 38% of all ocular burns—and 45% of all burns in children. While the study found that the causal agents varied between children and adults, chuna was the most common agent in both groups. 17% of the children presented with thermal burns (due to fireworks) and another 14% had superglue in their eyes. Over 60% of the children had low-grade burns and benefited from medical therapy. However, more children presented with the highest grade in the Dua grading system (Grade IV-VI) and their outcomes were poorer compared to the adults. A majority of both groups benefited from immediate ocular surface irrigation after injury.  

‘Ocular burns, when severe, are difficult to treat and affect different parts of the eye, thus requiring multiple surgical interventions,’ notes Dr Swapna Shanbhag, consultant ophthalmologist at LVPEI and one of the corresponding authors of this paper. ‘With this study, we would like to highlight the degree of corneal blindness caused by different agents that cause ocular burns. This opens up opportunities to implement policies to prevent these ocular burns from occurring in the first place.’  

Kate A, Sharma S, Yathish S, Das AV, Malepati N, Donthineni PR, et al. Demographic profile and clinical characteristics of patients presenting with acute ocular burns. Indian J Ophthalmol 2023;71:2694-703.  

Photo credit: Pan and areca nut preparation; by Vyacheslav Argenberg; CC BY 4.0. 

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