Thermal and chemical burns of the external surfaces of the body. Thermal burn of the cornea and conjunctiva Chemical burn of the conjunctiva ICD 10

15-10-2012, 06:52

Description

SYNONYMS

Chemical, thermal, radiation damage eye.

ICD-10 CODE

T26.0. Thermal burn eyelid and periorbital region.

T26.1. Thermal burn of the cornea and conjunctival sac.

T26.2. Thermal burn leading to rupture and destruction of the eyeball.

T26.3. Thermal burn of other parts of the eye and its adnexa.

T26.4. Thermal burn of the eye and its adnexa of unspecified localization.

T26.5. Chemical burn eyelid and periorbital region.

T26.6. Chemical burn of the cornea and conjunctival sac.

T26.7. Chemical burn leading to rupture and destruction of the eyeball.

T26.8. Chemical burn to other parts of the eye and its adnexa.

T26.9. Chemical burn of the eye and its adnexa of unspecified localization.

T90.4. Consequence of eye injury in the periorbital region.

CLASSIFICATION

• I degree- hyperemia various departments conjunctiva and limbal zones, superficial erosions of the cornea, as well as hyperemia of the skin of the eyelids and their swelling, slight swelling.
• II degree b - ischemia and superficial necrosis conjunctiva with the formation of easily removable whitish scabs, clouding of the cornea due to damage to the epithelium and superficial layers of the stroma, the formation of blisters on the skin of the eyelids.
• III degree- necrosis of the conjunctiva and cornea to deep layers, but not more than half the surface area of ​​the eyeball. The color of the cornea is “matte” or “porcelain”. Changes in ophthalmotonus are noted in the form of a short-term increase in IOP or hypotension. Possible development of toxic cataracts and iridocyclitis.
• IV degree- deep damage, necrosis of all layers of the eyelids (up to charring). Damage and necrosis of the conjunctiva and sclera with vascular ischemia on the surface of more than half of the eyeball. The cornea is “porcelain”, a tissue defect of more than 1/3 of the surface area is possible, in some cases a perforation is possible. Secondary glaucoma and severe vascular disorders- anterior and posterior uveitis.

ETIOLOGY

Conventionally, chemical (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and radiation burns are distinguished.

CLINICAL PICTURE

Common signs of eye burns:

• the progressive nature of the burn process after the cessation of exposure to the damaging agent (due to metabolic disorders in the tissues of the eye, the formation of toxic products and the occurrence of an immunological conflict due to autointoxication and autosensitization to the post-burn period);
• tendency to relapse inflammatory process V choroid at various times after receiving a burn;
• a tendency to the formation of synechiae, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.

Stages of the burn process:

• Stage I (up to 2 days) - rapid development of necrobiosis of affected tissues, excess hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acidic polysaccharides;
• Stage II (2-18 days) - manifestation of pronounced trophic disorders due to fibrinoid swelling:
• Stage III (up to 2-3 months) - trophic disorders and vascularization of the cornea due to tissue hypoxia;
• Stage IV (from several months to several years) is a period of scarring, an increase in the amount of collagen proteins due to increased synthesis by corneal cells.

DIAGNOSTICS

The diagnosis is made based on the history and clinical picture.

TREATMENT

Basic principles of treating eye burns:

• provision of emergency care aimed at reducing the damaging effect of the burn agent on tissue;
• subsequent conservative and (if necessary) surgical treatment.

When providing emergency care to a victim, it is necessary to intensively rinse the conjunctival cavity with water for 10-15 minutes, with obligatory eversion of the eyelids and rinsing of the lacrimal ducts, and careful removal of foreign particles.

Washing is not carried out in case of a thermochemical burn if a penetrating wound is detected!

Surgical interventions on the eyelids and eyeball early dates are carried out only for the purpose of preserving the organ. Vitrectomy of burned tissues, early primary (in the first hours and days) or delayed (after 2-3 weeks) blepharoplasty with a free skin flap or a skin flap on a vascular pedicle with a simultaneous transplantation of automucous tissue to inner surface eyelids, fornix and sclera.

Planned surgical interventions on the eyelids and eyeball for the consequences of thermal burns are recommended to be carried out 12-24 months after burn injury, since against the background of autosensitization of the body, allosensitization to the transplant tissue occurs.

For severe burns, it is necessary to inject 1500-3000 IU of antitetanus serum subcutaneously.

Treatment of stage I eye burns

Long-term irrigation of the conjunctival cavity (for 15-30 minutes).

Chemical neutralizers are used in the first hours after a burn. Subsequent use of these drugs is inappropriate and can have a damaging effect on the burned tissue. The following means are used for chemical neutralization:

• alkali - 2% solution boric acid, or 5% citric acid solution, or 0.1% lactic acid solution, or 0.01% acetic acid:
• acid - 2% sodium bicarbonate solution.

At severe symptoms intoxication is prescribed intravenously 1 time per day Belvidon 200-400 ml at night drip (up to 8 days after injury), or a 5% solution of dextrose with ascorbic acid 2.0 g in a volume of 200-400 ml, or a 4-10% solution dextran [cf. they say weight 30,000-40,000], 400 ml intravenously.

NSAIDs

H1 receptor blockers: chloropyramine (orally 25 mg 3 times a day after meals for 7-10 days), or loratadine (orally 10 mg once a day after meals for 7-10 days), or fexofenadine (orally 120-180 mg once a day after meals for 7-10 days).

Antioxidants: methylethylpyridinol (1% solution, 1 ml intramuscularly or 0.5 ml parabulbarly once a day, for a course of 10-15 injections).

Analgesics: metamizole sodium (50%, 1-2 ml intramuscularly for pain) or ketorolac (1 ml intramuscularly for pain).

Preparations for instillation into the conjunctival cavity

In severe conditions and early postoperative period the frequency of instillations can reach 6 times a day. As the inflammatory process decreases, the duration between instillations increases.

Antibacterial agents: ciprofloxacin ( eye drops 0.3%, 1-2 drops 3-6 times a day), or ofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or tobramycin 0.3% (eye drops, 1 -2 drops 3-6 times a day).

Antiseptics: picloxidine 0.05% 1 drop 2-6 times a day.

Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone ( eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisolone (eye drops 0.5% 1-2 drops 3-6 times a day).

NSAIDs: diclofenac (orally 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (orally 25 mg 2-3 times a day after meals, course 10-14 days).

Midriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day) in combination with phenylephrine (eye drops 2 .5% 2-3 times a day for 7-10 days).

Stimulators of corneal regeneration: actovegin (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or solcoseryl (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or dexpanthenol (eye gel 5% for the lower eyelid eyelid 1 drop 2-3 times a day).

Surgery: sectoral conjunctivotomy, corneal paracentesis, conjunctival and corneal necrectomy, genoplasty, corneal biocovering, eyelid plastic surgery, lamellar keratoplasty.

Treatment of stage II eye burns

Groups of drugs that stimulate immune processes, improve the body’s utilization of oxygen and reduce tissue hypoxia are added to the treatment.

Fibrinolysis inhibitors: aprotinin 10 ml intravenously, for a course of 25 injections; instillation of the solution into the eye 3-4 times a day.

Immunomodulators: levamisole 150 mg 1 time per day for 3 days (2-3 courses with a break of 7 days).

Enzyme preparations: systemic enzymes, 5 tablets 3 times a day, 30 minutes before meals, with 150-200 ml of water, the course of treatment is 2-3 weeks.

Antioxidants: methylethylpyridinol (1% solution 0.5 ml parabulbarly 1 time per day, for a course of 10-15 injections) or vitamin E (5% oil solution, 100 mg orally, 20-40 days).

Surgery: layered or penetrating keratoplasty.

Treatment III stages of eye burns

The following are added to the treatment described above.

Short-acting mydriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day).

Antihypertensive drugs: betaxolol (0.5% eye drops, 2 times a day), or timolol (0.5% eye drops, 2 times a day), or dorzolamide (2% eye drops, 2 times a day).

Surgery: keratoplasty for emergency indications, antiglaucomatous operations.

Treatment of stage IV eye burns

The following are added to the treatment:

Glucocorticoids: dexamethasone (parabulbar or under the conjunctiva, 2-4 mg, for a course of 7-10 injections) or betamethasone (2 mg betamethasone disodium phosphate + 5 mg betamethasone dipropionate) parabulbar or under the conjunctiva 1 time per week 3-4 injections. Triamcinolone 20 mg once a week, 3-4 injections.

Enzyme preparations in the form of injections:

• fibrinolysin [human] (400 units parabulbar):
• collagenase 100 or 500 KE (the contents of the bottle are dissolved in 0.5% procaine solution, 0.9% sodium chloride solution or water for injection). Injected subconjunctivally (directly into the lesion: adhesions, scar, ST, etc. using electrophoresis, phonophoresis, and also applied cutaneously. Before use, check the sensitivity of the patient, for which 1 KU is injected under the conjunctiva of the diseased eye and observed for 48 hours. absence allergic reaction treatment is carried out for 10 days.

Non-drug treatment

Physiotherapy, eyelid massage.

Approximate periods of incapacity for work

Depending on the severity of the lesion, it takes 14-28 days. Disability is possible if complications or loss of vision occur.

Further management

Observation by an ophthalmologist at your place of residence for several months (up to 1 year). Monitoring of ophthalmotonus, CT state, retina. With a persistent increase in IOP and no compensation for medication regimen antiglaucomatous surgery is possible. During development traumatic cataract removal of the cloudy lens is indicated.

FORECAST

Depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the victim’s admission to the hospital, and the correctness of drug therapy.

Article from the book: .

Chemical burns to the organs of vision occur due to contact with aggressive chemicals. They cause damage anterior section eyeball, cause unpleasant symptoms: pain, irritation and can lead to vision problems.

An eye burn is not a disease, but pathological condition, which can be eliminated if you consult an ophthalmologist in time.

List of symptoms:

1. Sharp pain In eyes. But this will help you understand why pain occurs in the eyeball when pressed. this information.
2. Redness of the conjunctiva.
3. Discomfort, burning sensation, irritation.
4. Increased tear production.

It is difficult not to notice chemical damage to the organ of vision. It's all about pronounced symptoms, which gradually increase.

Chemical substances act gradually. Once on the skin of the eyes, they cause irritation, but if the burn is left unattended, its manifestations will only intensify.

Aggressive reagents gradually damage the skin of the eyelids and eyes. The extent of the “injuries” inflicted and their severity can be assessed after 2–3 days. But what types of eyelid diseases there are in humans and what drops should be used are indicated in this article.

Classification of burns

The video shows a description of a chemical burn to the eye:

Clinical manifestations

1. Damage to the surface of the skin of the eyelids.
2. The presence of foreign substances in the tissues of the conjunctiva. But what the symptoms of eye conjunctivitis in children may be can be seen here.
3. Level up within eye pressure(ocular hypertension).

Extensive damage to the skin occurs upon contact with reagents. The substances irritate the mucous membrane, which leads to redness and irritation of the anterior parts of the eyeball.

During an ophthalmological examination, particles of foreign substances are detected; they are clearly visible when clinical examination. Carrying out research helps to determine which substance led to the development of damage (acid, alkali).

The reagents act on parts of the eyeball in a special way. Contact results in “desiccation” or drying out of the mucosal surface and an increase in intraocular pressure levels. But what are the symptoms of high eye pressure in adults is described in great detail in this article.

Assessing the totality of symptoms helps to make the correct diagnosis for the patient. The ophthalmologist determines the degree of burn, conducts diagnostic procedures and selects appropriate treatment.

ICD-10 code

• T26.5 – chemical burn and area around the eyelid;
• T26.6 – chemical burn with reagents with damage to the cornea and conjunctival sac;
• T26.7 – severe chemical burn with tissue damage leading to rupture of the eyeball;
• T26.8 – chemical burn affecting other parts of the eye;
• T26.9 - a chemical burn that affected the deep parts of the eyeball.

If the tissues of the eyeball, eyelids and conjunctiva are damaged, the patient needs first aid.

So, the principles of its provision:

Do not wash your eyes with running water or use cosmetic creams. This may increase signs of chemical exposure.

Once on the skin, the cream creates a protective shell on top, as a result of which the effect of aggressive reagents is enhanced. For this reason, it should not be applied to skin creams or other cosmetic products.

What medications can you use:

The potassium permanganate solution should be weak, it will help neutralize the effect of aggressive substances. You can dilute potassium permanganate, prepare furatsilin, or simply rinse your vision with warm, slightly salted water.

You should wash your eyes as often as possible, every 20–30 minutes. If the symptoms are severe, then you can take painkillers: Ibuprofen, Analgin or any other painkillers.

Treatment

It is advisable to consult a doctor when the first signs of a chemical burn appear. The doctor will select adequate therapy and help reduce unaccepted symptoms.

Most often the following drugs are prescribed for treatment:

Antiseptics are part of combination therapy; they stop the inflammatory process and promote the restoration of soft tissues, relieve swelling and redness.

Antibacterial drugs prescribed to relieve the inflammatory process. They contribute to death pathogenic microflora and accelerate the process of cell regeneration.

Anti-inflammatory drugs also include glucocorticosteroids; they enhance the effect of antibacterial medications and antiseptics. With regular use, they reduce the intensity of unpleasant symptoms.

Painkillers local action used in the form of drops. They help reduce the intensity of the expression pain syndrome.

If there is an increase in the level of intraocular pressure (most often diagnosed upon contact with alkalis), then medications are used that reduce the symptoms intraocular hypertension.

Medicines based on human tears. They help soften the irritated conjunctiva and reduce signs of the inflammatory process, remove swelling and partially hyperthermia of the eyelid.

List of drugs prescribed for eye burns:

Solcoseryl is available in the form of an ointment; the drug significantly speeds up the healing process and helps to avoid pronounced scarring of the tissue. And taurine as a substance “inhibits” development irreversible changes in parts of the eyeball.

Timolol is the substance that ophthalmologists prefer when signs of high intraocular pressure appear.

What to do if a chemical burn to the eye occurs after eyelash extensions?

Getting burned while doing eyelash extensions occurs for several reasons. This can be caused by heat - thermal damage or chemicals (contact with the skin of the eyelids or mucous membranes of glue).

If you have problems with eyelash extensions, you should following procedures:

• rinse your eyes with a solution of potassium permanganate. But what to use to wash your eye if you get a speck of debris in it, the information in the link will help you understand.
• drip Taurine or any other drops into the eyeballs to reduce the inflammatory process (you can use drugs based on human tears);
• consult a doctor for help.

If the damage is local, then contacting an ophthalmologist is necessary. Since only a doctor will be able to assess the seriousness of the situation and provide the patient with adequate assistance.

In the video there is an eye burn after eyelash extensions:

If glue gets on your skin, there is a risk of developing blepharitis and other diseases. inflammatory in nature. To prevent this from happening, it is necessary to take appropriate measures and consult an ophthalmologist as soon as possible. But how to properly use Kosopt eye drops and what their price is can be seen in this article.

You will also need to remove the eyelash extensions, since the glue irritates the skin of the eyelids and leads to increased unpleasant symptoms.

A chemical burn to the organs of vision is a serious injury that requires immediate treatment. You can provide first aid yourself, but subsequent treatment should preferably be carried out under the supervision of a doctor.

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Thermal and chemical burns limited to the area of ​​the eye and its adnexa

ICD-10 → S00-T98 → T20-T32 → T26-T28 → T26.0

Thermal burn of the eyelid and periorbital area

Thermal burn of the cornea and conjunctival sac

Thermal burn leading to rupture and destruction of the eyeball

Thermal burn of other parts of the eye and its adnexa

Thermal burn of the eye and its adnexa of unspecified localization

Chemical burn of the eyelid and periorbital area

Chemical burn of the cornea and conjunctival sac

Chemical burn leading to rupture and destruction of the eyeball

Chemical burn to other parts of the eye and its adnexa

Chemical burn of the eye and its adnexa of unspecified localization

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International statistical classification of diseases and related health problems. 10th revision.

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ICD-10, T26, thermal and chemical burns limited to the area of ​​the eye and its adnexa

More information about the ICD-10 classifier

Date of placement in the database 03/22/2010

Relevance of the classifier: 10th revision of the International Classification of Diseases

Showing 10 entries

Home → INJURIES, POISONING AND SOME OTHER CONSEQUENCES OF EXTERNAL CAUSES → THERMAL AND CHEMICAL BURNS → THERMAL AND CHEMICAL BURNS OF THE EYE AND INTERNAL ORGANS → Thermal and chemical burns limited to the area of ​​the eye and its appendages apparatus

Code Name

T26.0	Thermal burn of the eyelid and periorbital area
T26.1	Thermal burn of the cornea and conjunctival sac
T26.2	Thermal burn leading to rupture and destruction of the eyeball
T26.3	Thermal burn of other parts of the eye and its adnexa
T26.4	Thermal burn of the eye and its adnexa of unspecified localization
T26.5	Chemical burn of the eyelid and periorbital area
T26.6	Chemical burn of the cornea and conjunctival sac
T26.7	Chemical burn leading to rupture and destruction of the eyeball
T26.8	Chemical burn to other parts of the eye and its adnexa
T26.9	Chemical burn of the eye and its adnexa of unspecified localization

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An eye burn can be caused by thermal, chemical or radiation exposure, which requires immediate medical attention. Accompanied by severe pain, blurred vision, swelling of the eyelids, with the conjunctiva - the outer membrane that covers the eyeball.

ICD-10 code: T26 Thermal and chemical burns limited to the eye and its adnexa

Signs of a burn

The photo shows a chemical burn to the eye due to exposure to a chemical.

The organ of vision can be damaged:

• open fire;
• boiling water and steam;
• chemical effects on the eyeball (lime, acid and alkali);
• less often it is affected by ultraviolet and infrared radiation;
• Ionizing damage to the organs of vision occurs under the influence of radiation sources.

Symptoms of a burn include the following:

Signs and symptoms of eye burns in the photo

• A mild degree is manifested by sharp pain, redness and slight swelling of the surrounding tissue. There is a feeling of being hit foreign body, violation of the contrast of vision of objects, blurred vision.
• Under influence high temperature On the organs of vision, the conjunctiva dies. As a result, ulcers form, which lead to the fusion of the eyelid with the eyeball.
• When the cornea, the front convex part of the eye, is damaged, lacrimation and photophobia occur, vision is impaired from simple deterioration to complete loss.
• When the iris of the eye is damaged, which regulates the dilation and contraction of the pupil and clouding of the retina, the organ of vision becomes inflamed and vision decreases. Infection of the resulting wounds leads to damage, and deep chemical burns cause perforation and death of the eye.

Initial assistance is carried out at the scene of the accident - it consists of rinsing the eye and applying medicines. More intensive treatment is provided in a medical facility.

Burn diagnostic methods

Diagnosis of an eye burn using visual assessment at the scene

An eye burn is diagnosed by history and clinical picture. Anamnesis is a summary of information obtained from interviewing the patient and those present at the accident. Clinical picture supplements the anamnesis with symptoms (single manifestations of the disease) and syndromes (the totality of the occurrence and development of the disease).

Treatment of eye burns

First aid is provided at the scene of the accident, then the patient is taken to the ophthalmology center. An eye burn is treated in the following sequence:

Primary treatment measures

1. Flush the affected eye generously with saline or water.
2. Washing the lacrimal ducts, removing foreign bodies.
3. Instillation of pain relievers.

Subsequent treatment in hospital

1. Instillation of cytoplegic agents that reduce painful sensations and prevent the formation of adhesions.
2. Tear substitutes and antioxidants are used.
3. To stimulate the corneal restoration process, eye gels are applied.

When treated without medication in case of complex nature and large area of ​​eye damage, for example, with a chemical burn of the cornea, active substances delete surgical method. Surgical interventions are performed on the eyeball or conjunctiva.

Probable forecast

Overgrowth of an eyesore after a burn

Prognosis for burn injuries to the eyes is determined by the nature and severity of the injury. The urgency of the specialized medical care provided and the correctness of drug therapy are important.

In case of severe injuries, the conjunctival plane usually forms, overgrows, and decreases visual function and complete atrophy of the eyeball with total loss vision. After a successful outcome of treatment after an eye burn, the patient is observed by a specialist for a year.

Complications from a burn

An example of complications on the cornea and sclera after an eye burn

The pathological process after a burn is often protracted with relapses of inflammation. Corneal regeneration does not end there full recovery connective tissues with suppression of the inflammatory process.

A complication of the healing process of corneal tissue is deterioration in vision, repeated inflammation or erosion of the cornea and hardening of the tissue through long time after operation.

In severe cases, glaucoma may develop, which leads not only to decreased vision, but also to loss of the sense of color. And disturbances in the normal metabolism in the organ of vision lead to a deterioration in its supply of nutrients. Often the injury manifested itself years later as a depressed state, or overexcitement of the patient in the form of a decrease in blood pressure.

How to prevent eye burns?

To prevent serious injury eyes, you should strictly adhere to safety precautions when handling:

• chemicals;
• substances that are easily flammable;
• household chemicals.

Eye protection sunburn— safety glasses with light filters

To prevent radiation damage to the eyes, you should use protective glasses with light filters.

Burn injury to the eyes is a complex injury. But if the patient was immediately provided with competent medical care and the diagnosis was made correctly, the organ of vision can be saved.

The photo shows an extensive burn of the cornea with subsequent healing of the eyesore

In the case where further treatment was carried out in full in a specialized clinic, the tissue restoration of the eyeball is successful, and complications are not detected by doctors.

In contact with

This is an eye burn emergency requiring immediate action. Eye burns, whether thermal or chemical, are among the most dangerous and can cause vision loss. Caustic substances may cause limited or diffuse damage to the cornea. The consequences of burns depend on the type and concentration of the solution, pH, duration and temperature of the substance.

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ICD-10 code

T26.4 Thermal burn of the eye and its adnexa, unspecified localization

T26.9 Chemical burn of the eye and its adnexa, unspecified localization

Causes of eye burns

Eye injuries most often result from contact with chemicals, thermal agents, various radiations, electric shock.

• Alkalis(slaked or quicklime, lime mortar) upon contact with the eyes lead to the most serious burns, causing necrosis and destroying the tissue structure. The conjunctiva takes on a greenish tint, and the cornea becomes porcelain white.
• Acids. Acid burns are not as serious as alkaline burns. The acid causes the corneal protein to clot, which prevents damage to more deep structures eyes.
• Ultraviolet radiation . An eye burn from ultraviolet radiation can occur after tanning in a solarium, or if you look at bright Sun rays reflected from the surface of water or snow.
• Hot gases and liquids. The stage of the burn depends on the temperature and duration of exposure.
• Feature electric shock is painlessness, a clear distinction between healthy and dead tissue. Severe burns provoke eye hemorrhages and retinal swelling. Clouding of the cornea also occurs. When exposed to electric current, both eyes are often affected.

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Eye burn from welding

When the welding machine operates, an electric arc is generated that emits ultraviolet radiation. This radiation can cause electroophthalmia (severe burn of the mucous membrane). The reasons for the occurrence are non-compliance with safety regulations, powerful ultraviolet and infrared radiation, the effect of welding smoke on the eyes. Symptoms: uncontrollable lacrimation, sharp pain, eye hyperemia, swollen eyelids, pain when moving eyeballs, photophobia. If electroophthalmia occurs, it is forbidden to rub your eyes with your hands, since rubbing only intensifies the pain and leads to the spread of inflammation. It is important to immediately wash the eyes. If the retina is not damaged by the burn, then vision will be restored within one to three days.

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Risk factors

Stages

Burns come in four stages. The first is the easiest, respectively, the fourth is the heaviest.

• The first degree is redness of the eyelids and conjunctiva, clouding of the cornea.
• Second degree - blisters and superficial films on the conjunctiva form on the skin of the eyelids.
• Third degree - necrotic changes in the skin of the eyelids, deep films on the conjunctiva that are practically not removed and a clouded cornea that resembles opaque glass.
• The fourth degree is necrosis of the skin, conjunctiva and sclera with deep opacification of the cornea. An ulcer forms in place of the necrotic areas, the healing process of which ends with scars.

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Diagnosis of eye burns

As a rule, there are no problems with diagnosing an eye burn. Installed on base characteristic symptoms and interviewing the patient or witnesses to the event. The diagnosis should be made as soon as possible. Using tests and examination: the doctor determines the factor that caused the burn and draws up a conclusion.

After graduation acute period, in order to assess damage, it is recommended to conduct instrumental and differential diagnostics - external examination of the eye using an eyelid lifter, measure intraocular pressure, conduct biomicroscopy to identify ulcers on the cornea, ophthalmoscopy.

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Treatment of eye burns

Urgent Care, is aimed at determining which substance caused the burn. IN as soon as possible it is necessary to remove the irritant from the eye. It can be removed with a tissue or cotton swab. If possible, the material is removed from the conjunctiva by everting upper eyelid and clean it with a tampon. Then rinse the affected eye with water or a disinfectant solution such as two percentage solution boric acid, three percent tannin solution or other liquids. Rinsing should be repeated for several minutes. To reduce the accompanying burn severe pain and fear, you can anesthetize the patient and give sedatives.

You can use a dicaine solution (0.25-0.5%) for drip anesthesia. A sterile bandage is then placed on the eye, covering the entire eye, and then the patient is immediately transported to the hospital for further actions to preserve vision. In the future, it is necessary to fight to prevent fusion of the eyelids and destruction of the cornea.

It is recommended to place a pad of gauze on the eyelids, which is soaked in antiseptic ointment, using drops of eserine 0.03%. It is allowed to use eye drops with antibiotics:

• tobrex 0.3% (instill 1-2 drops every hour; contraindications – intolerance to any component of the drug; can be prescribed to children from birth.),
• signicef ​​0.5% (1-2 drops every two hours up to eight times a day, reducing the dosage to four times a day. The duration of treatment is determined individually. Side effects are local allergic reactions.),
• drops of chloramphenicol 0.25% instilled with a pipette once three times a day, one drop)
• Taufon drops 4% (locally, in the form of instillation two or three drops 3-4 times a day. There are no contraindications or side effects),
• at severe conditions Dexamethasone is prescribed (can be prescribed both locally and by injection, 4–20 mg intramuscularly three times a day).

Do not allow the damaged eye to dry out. To prevent this from happening, apply generous lubrication with Vaseline and xeroform ointment. Anti-tetanus serum is administered. For general support of the body in case of a burn of the cornea of ​​the eye in rehabilitation period It is recommended to prescribe vitamins. They are used orally or as intramuscular or intravenous injections.

Massage and physiotherapeutic treatment can be used to improve blood circulation.

Target inpatient treatment- this is the maximum preservation of eye function. For first and second degree burns, the prognosis is favorable. With the last two it is shown surgical treatment- layer-by-layer or penetrating keratoplasty.

After the acute phase of the burn has passed, you can use folk, homeopathic and herbal remedies.

Treatment of burns with traditional methods

You need to eat as much as possible more carrots, as it contains carotene, which is beneficial for our eyes.

Add to your diet fish fat. It contains nitrogenous material and polysaturated acids that promote tissue restoration.

For a minor burn from electric welding, you can cut a potato in half and apply it to your eyes.

Herbal treatment

One tablespoon of dried clover flowers is poured into one glass of boiling water and left for one hour. Use for external use.

Dry thyme (one spoon) is poured with one glass of boiling water. Let it brew for one hour. Apply externally.

Pour twenty grams of crushed plantain leaves into 1 cup of boiling water and leave for one hour. For external use.

Homeopathic remedies

• Oculoheel - the drug is used for eye irritation and conjunctivitis. Anti-inflammatory. Prescribed for adults: one or two drops twice a day. There are no contraindications. There are no known side effects.
• Mucosa compositum - used for inflammatory, erosive diseases of the mucous membranes. At the beginning of treatment, one ampoule is prescribed every day for three days. There are no known side effects. There are no contraindications.
• Gelseminum. Gelseminum. Active substance Made from the underground part of the Gelsemium evergreen plant. Recommended for relieving acute stabbing pain in the eye, glaucoma. Adults take 8 granules three to five times daily.
• Aurum. Aurum. A remedy for deep lesions of organs and tissues. Recommended intake for adults: 8 granules 3 times a day. It has no contraindications.

All given in this article are traditional and not traditional methods Treatments are for informational purposes only. What may have a positive effect on one person may not work for another. Therefore, do not self-medicate, visit a specialist.

Prevention

Experts say that in most cases, burns can be prevented. Preventive actions can be reduced to easy execution safety rules when working with flammable liquids, chemicals, household chemicals, and working with electrical appliances. When you are in bright sunshine, wear Sunglasses. Patients who have suffered corneal burns are recommended to be followed by an ophthalmologist for one year after the injury.

Protocol for providing medical care for thermal burns of the cornea and conjunctival sac

ICD code - 10
T 26.1
T 26.2
T 26.3
T 26.4

Signs and diagnostic criteria:

A thermal burn occurs due to exposure of tissue to a thermal factor: flame, steam, hot liquids, hot gases, light irradiation, molten metal.

The severity of the burn depends on the degree of necrosis (area and depth).

Burn degree	Cornea	Conjunctiva
	Islet fluorescein staining, dull surface;	Hyperemia, islet staining
second	Easily removable film, deepithelialization, continuous coloring	Pallor, gray films that are easily removed
third A	Superficial opacification of the stroma and Bowman's membrane, folds of Descemet's membrane (even while maintaining its transparency)	Pallor and chemosis
third B	Deep stromal opacification, but without early changes in the iris, severe loss of sensitivity at the limbus	Exposure and partial rejection of the livid sclera
fourth	Simultaneously with changes in the cornea up to the detachment of Descemet's membrane, depigmentation of the iris and immobility of the pupil, clouding of the moisture of the anterior chamber and lens	Melting of the exposed sclera to the vascular tract, clouding of the moisture of the anterior chamber and lens, vitreous body

Burns are divided according to severity:
The easiest- I degree of any localization and plane
Easy- II degree of any localization and plane
Moderate- degree III - A for the cornea - outside the optical zone, for the conjunctiva and sclera - limited (up to 50% of the arch)
Heavy- degree III - B and degree IV - for the cornea - limited, but with damage to the optical zone; for the conjunctiva - widespread, more than 50% of the fornix.

For burns starting from the second degree, tetanus prophylaxis is mandatory.

Levels of medical care:
Second level - ophthalmologist of the clinic (1st degree burns)
Third level - ophthalmology hospital (starting with second degree burns), trauma center

Examinations:
1. External inspection
2. Visometry
3. Perimetry
4. Biomicroscopy

Mandatory laboratory tests:
(Urgent hospitalization, later)
1. General analysis blood
2. General urine test
3. Blood on RW
4. Blood sugar
5. Hbs antigen

Consultations with specialists according to indications:
1. Therapist
2. Surgeon - combustiologist

Characteristics of treatment measures:

First degree burn of the cornea and conjunctiva - outpatient treatment

Second degree burn of the cornea and conjunctiva - conservative treatment in hospital;

Corneal burn of III A degree - necrectomy and layered keratoplasty or superficial therapeutic transplantation of the cornea, conjunctiva - conjunctivotomy according to Pasov, Denig's operation (transplantation of the oral mucosa) in the modification of Puchkovskaya or according to Shatilova

Corneal burn of III B degree - penetrating keratoplasty, conjunctival burn - Denig's operation (transplantation of the oral mucosa) in the modification of Puchkovskaya or according to Shatilova

IV degree burns of the cornea and conjunctiva - transplantation of a piece of the oral mucosa onto the entire anterior surface of the eye and blepharorrhaphy.

Conservative treatment:
1. mydriatics
2. antibacterial drops (sulfacyl sodium, chloramphenicol, gentamicin, tobramycin, okacin, ciprolet, normax, ciprofloxacin and others) parabulbar antibiotics (gentamicin, tobramycin, carebenicillin, penicillin, netromycin, lincomycin, kanamycin, etc.) ointments (chloramphenicol, erythromycin, tetracycline, sodium sulfacyl)
3. anti-inflammatory (naklof, diklo-F, corticosteroids - in drops and parabulbar)
4. inhibitors of protility enzymes (gordox, contrical)
5. antihypertensive therapy when indicated (timolol, betoptik and others)
6. antitoxic therapy (hemodesis, intravenous rheopolyglucin)
7. antioxidant drops (emoxipine, 5% alpha-tocopherol)
8. means that regulate metabolism and trophism (taufon, sea ​​buckthorn oil, actovegin and solcoseryl gels, retinol acetate, quinax, oftan-catachrome, kerakol and others), under the conjunctiva - ascorbic acid, ATP, riboflavin mononucleotides
9. systemic therapy - antibiotics orally, intramuscularly, intravenously; anti-inflammatory (orally - indomethacin, diclofenac, intramuscularly - Volt Arena, diclofenac); antihypertensives (diacarb, glyceryl); therapy against autosensitization and autointoxication (i.v. calcium chloride, i.m. - diphenhydramine, suprastin, orally - diphenhydramine, tavegil, suprastin); means regulating metabolism (i.m. actovegin, vitamins B1, B2, ascorbic acid); vasodilator therapy (orally - Cavinton, no-spa, nicotinic acid, intravenously - Cavinton, rheopolyglucin, intramuscularly - nicotinic acid)

III-IV degree burns are subject to treatment at the traumatology and burn center of the Institute of Eye Diseases and Tissue Therapy named after. acad. V. P. Filatova AMS of Ukraine

Final expected result- organ-preserving effect, preservation of vision

Duration of treatment
First degree burns - 3 - 5 days
Second degree burns - 7-10 days
Third degree burns (A and B) - 2-4 weeks
Fourth degree burns - 2 months

Treatment quality criteria:
First and second degree burns - recovery
Third degree burns (A and B) - organ-preserving effect, absence of symptoms of inflammation, decreased function, which does not significantly affect performance or disability and may maintain prospects for partial restoration of function
Fourth degree burns - loss of eye, disability

Possible side effects and complications:
Eye infections, eye loss

Dietary requirements and restrictions:
No

Requirements for the regime of work, rest and rehabilitation:
Patients are disabled: first degree - 1 week, second degree - 3-4 weeks; third degree - 4-6 weeks; fourth degree - partial permanent loss of ability to work, disability. 4th degree burns require further repeated hospital treatment within a year
Disability is determined by the degree of burn, volume surgical intervention, the need for late reconstructive operations.