Thermal burn of the cornea and conjunctiva. Eye burns Chemical eye burn ICD

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 damage most often occurs as a result of 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 ultraviolet eye burn can occur after tanning in a solarium, or if you look at bright sunlight 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, and the effect of smoke generated during welding on the eyes. Symptoms: uncontrollable lacrimation, sharp pain, eye hyperemia, swollen eyelids, pain when moving the 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. It is established on the basis of characteristic symptoms and interviews with the patient or witnesses to the event. The diagnosis should be made as quickly 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 - an external examination of the eye using an eyelid lifter, measure intraocular pressure, conduct biomicroscopy to identify ulcers on the cornea, and ophthalmoscopy.

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Treatment of eye burns

Emergency care is aimed at determining what 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 the upper eyelid and cleaning it with a swab. Then rinse the affected eye with water or a disinfectant solution such as a two percent 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– local allergic reactions.),
• drops of chloramphenicol 0.25% instilled with a pipette once three times a day, one drop)
• Taufon drops 4% (topically, in the form of instillation two or three drops 3-4 times a day. Contraindications and side effects No),
• in severe conditions, dexamethasone is prescribed (can be prescribed both locally and by injection, 4–20 mg intramuscularly three to four 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 maintenance of the body in case of a corneal burn, it is recommended to prescribe vitamins during the rehabilitation period. They are used orally or as intramuscular or intravenous injections.

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

The goal of inpatient treatment is to preserve eye function as much as possible. 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. The active substance is 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.

RCHR ( Republican Center healthcare development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols Ministry of Health of the Republic of Kazakhstan - 2015

Thermal and chemical burns limited to the eye and adnexa (T26)

Ophthalmology

general information

Short description

Recommended
Expert advice
RSE at PVC "Republican Center for Health Development"
Ministry of Health
And social development
dated October 15, 2015
Protocol No. 12

Burns limited to the area of ​​the eye and its adnexa- this is damage to the eyeball and tissues around the eye due to chemical, thermal and radiation damaging agents.

Protocol name: Thermal and chemical burns limited to the area of ​​the eye and its adnexa.

ICD-10 code(s):

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, 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, unspecified localization

Abbreviations used in the protocol:
ALT - alanine aminotransferase

AST - aspartate aminotransferase
IV - intravenous
V\m - intramuscular
GKS - glucocorticosteroids
INR - international normalized ratio
P\b - parabulbar
P\c - subcutaneously
PTI - prothrombin index
UD - level of evidence
ECG - electrocardiographic examination

Date of protocol development/revision: 2015

Protocol users: therapists, pediatricians, doctors general practice, ophthalmologists.

Assessment of the degree of evidence of the recommendations provided.
Level of evidence scale:

Level evidence	Type Evidence
	Evidence obtained from meta-analysis large number well-designed randomized trials. Randomized trials with low level false positive and false negative errors.
	The evidence is based on the results of at least one well-designed randomized trial. Randomized trials with high level false positive and false negative errors
III	The evidence is based on well-designed, non-randomized studies. Controlled studies with one group of patients, studies with a historical control group, etc.
	Evidence comes from non-randomized studies. Indirect comparative, descriptive correlational and case studies
V	Evidence based on clinical cases and examples

Classification

Clinical classification
Depending on the influencing factor:
· chemical;
· thermal;
· radial;
· combined.

By anatomical location of damage:
· auxiliary organs (eyelids, conjunctiva);
· eyeball (cornea, conjunctiva, sclera, underlying structures);
· several adjacent structures.

According to the severity of damage:
· I degree - mild;
· II degree - medium degree;
· III (a and b) degrees - severe;
· IV degree - very severe.

Diagnostics

List of basic and additional diagnostic measures:
Diagnostic measures carried out at the stage of emergency care:
· collection of medical history and complaints.
Basic (mandatory) diagnostic examinations performed on an outpatient basis:
· visometry (UD - C);
· ophthalmoscopy (UD - C);

· biomicroscopy of the eye (UD - C).
Additional diagnostic examinations performed on an outpatient basis:
· perimetry (UD - C);
· tonometry (UD - C);
· echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C);

Basic (mandatory) diagnostic examinations carried out on stationary level in case of emergency hospitalization and after a period of more than 10 days has passed from the date of testing in accordance with the order of the Ministry of Defense:
· collection of complaints, medical history and life history;
· general analysis blood;
· general urine analysis;
· biochemical analysis blood ( total protein, its fractions, urea, creatinine, bilirubin, ALT, AST, electrolytes, blood glucose);
· coagulogram (PTI, fibrinogen, FA, clotting time, INR);
· microreaction;
blood test for HIV method ELISA;
· determination of HBsAg in blood serum by ELISA method;
· determination of total antibodies to the hepatitis C virus in blood serum by ELISA method;
· determination of blood group according to the ABO system;
Determination of the Rh factor of blood;
· visometry (UD - C);
· ophthalmoscopy (UD - C);
· determination of corneal surface defects (UD - C);
· biomicroscopy of the eye (UD - C);
· ECG.
Additional diagnostic examinations carried out at the hospital level during emergency hospitalization and after more than 10 days have passed from the date of testing in accordance with the order of the Ministry of Defense:
· perimetry (UD - C);
· tonometry (UD - C);
· echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C)*;
· radiography of the orbit (if there are signs of combined damage to the eyelids, conjunctiva and eyeball, to exclude foreign bodies) (UD - C).

Diagnostic criteria for diagnosis:
Complaints and anamnesis
Complaints:
· pain in the eye;
· lacrimation;
· severe photophobia;
· blepharospasm;
· decreased visual acuity.
Anamnesis:
· clarification of the circumstances of the eye injury (type of burn, type chemical substance).

Instrumental studies:
Visometry - decreased visual acuity;
· biomicroscopy - violation of the integrity of the structures of the eyeball, depending on the severity of the damage;
· ophthalmoscopy - weakening of the fundus reflex;
· determination of corneal surface defects - the area of ​​corneal damage depending on the severity of the burn;

Indications for consultation narrow specialists:
consultation with a therapist - for assessment general condition body.

Differential diagnosis

Differential diagnosis.
Table - 1. Differential diagnosis of eye burns by severity

Burn degree	Leather	Cornea	Conjunctiva and sclera
I	skin hyperemia, superficial exfoliation of the epidermis.	islanded fluorescein staining, dull surface	hyperemia, islet staining
II	formation of blisters, peeling of the entire epidermis.	film that can be easily removed, deepithelialization, continuous staining.	pallor, gray films that are easily removed.
III a	necrosis of the superficial layers of the skin itself (up to the germ layer)	superficial opacification of the stroma and Bowman's membrane, folds of Descemet's membrane (if its transparency is preserved).	pallor and chemosis.
III in	necrosis of the entire thickness of the skin	deep clouding of the stroma, but without early changes in the iris, a sharp violation of sensitivity at the limbus.	exposure and partial rejection of the livid sclera.
IV	deep necrosis of not only the skin, but also subcutaneous tissue, muscles, cartilage.	simultaneously with changes in the cornea up to the detachment of Descemet’s membrane (“porcelain plate”), 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.

Table 2. Differential diagnosis chemical and thermal burns of the eye

Nature of damage	Alkali burn	Acid burn
type of damage	liquefaction necrosis	coagulative necrosis
intensity of primary corneal opacification	poorly expressed	strongly expressed
depth of damage	corneal opacity does not correspond to the depth of tissue damage	corneal opacity corresponds to the depth of tissue damage
damage to the cavity structures of the eye	fast	slow
development of iridocyclitis	fast	slow
neutralizers	2% boric acid solution	3% bicarbonate of soda solution

Treatment

Treatment goals:
· decrease inflammatory reaction eye tissue;
· cupping pain syndrome;
· restoration of the surface (epithelialization) of the eye.

Treatment tactics:
· for first degree burns - treatment is carried out on an outpatient basis, under the supervision of an ophthalmologist;
· for burns of II-IV degrees - emergency hospitalization in a hospital is indicated.

Drug treatment:
Drug treatment provided at the emergency stage:


Drug treatment provided on an outpatient basis (for burnsI degrees) :
· if there is a powdered chemical substance or its pieces on the eyelids and conjunctiva, remove it with damp cotton wool or gauze;
· local anesthetics (oxybuprocaine 0.4% or proximetacaine 0.5%), 1-2 drops into the conjunctival cavity once (UD - C);
· abundant, long-term (at least 20 minutes) rinsing of the conjunctival cavity with cool (12 0 -18 0 C) running water or water for injection (the patient’s eyes should be open while rinsing);

mydriatics (the choice of drugs is at the discretion of the doctor) - cyclopentolate 1%, tropicamide 1%, phenylephrine ophthalmic 2.5% and 10% epibulbar 1-2 drops up to 3 times a day for 3-5 days to prevent development inflammatory process in the anterior part of the vascular tract (UD - C);

Drug treatment provided at the inpatient level:
BurnsIIdegrees:
local anesthetics (oxybuprocaine 0.4% or proximetacaine 0.5%) in the form of instillations before washing the conjunctival cavity, immediately before surgical intervention, pain relief if necessary (UD - C);
· in case of a chemical burn, abundant, long-term (at least 20 minutes), continuous irrigation of the conjunctival cavity with an alkali neutralizer (2% boric acid solution or 5% citric acid solution or 0.1% lactic acid solution or 0.01% solution acetic acid), for acids (2% sodium bicarbonate solution). Chemical neutralizers are used during the first hours after a burn; subsequently, the use of these drugs is inappropriate and can have a damaging effect on the burned tissue (UD - C);
· in case of a thermal burn, rinse with cool (120-180C) running water/water for injection (the patient’s eyes should be open while rinsing).
· washing is not carried out in case of a thermochemical burn when a penetrating wound is detected;
· local antibacterial agents(chloramphenicol ophthalmic 0.25% or ciprofloxacin ophthalmic 0.3% or ofloxacin ophthalmic 0.3%) - children over 1 year and adults immediately after washing the conjunctival cavity, as well as 1 drop 4 times a day epibulbarically for 5-7 days (for prevention infectious complications) (UD - C);
· antibacterial agents for local external use (ofloxacin ophthalmic 0.3% or tobramycin 0.3%) - for children over 1 year and adults 2-3 times a day on the burn surface (according to indications) (UD - C);
· non-steroidal anti-inflammatory drugs (diclofenac ophthalmic 0.1%) - 1 drop 4 times a day epibulbarically (in the absence of epithelial defects) for 8-10 days. (UD - C);
mydriatics - atropine ophthalmic 1% (adults), 0.5%, 0.25%, 0.125% (children) 1 drop 1 time per day epibulbarically, cyclopentolate 1%, tropicamide 1%, phenylephrine ophthalmic 2.5% and 10% epibulbar 1-2 drops up to 3 times a day for the purpose of prevention and treatment of the inflammatory process in the anterior part of the vascular tract (UD - C);
· regeneration stimulants, keratoprotectors (dexpanthenol 5 mg) - 1 drop 3 times a day epibulbar. In order to improve the trophism of the anterior surface of the eyeball, accelerate the healing of erosions (UD - C);
· when increasing within eye pressure: non-selective “B” blockers (timolol 0.25% and 0.5%) -. Contraindicated for: bronchial obstruction, bradycardia less than 50 beats per minute, systemic hypotension; Carbonic anhydrase inhibitors (dorzolamide 2%, or brinzolamide 1%) - epibulbar 1 drop 2 times a day (UD - C);
· for pain - analgesics (ketorolac 1 ml i.m.) as needed (UD - C);

BurnsIII- IVdegrees(additionally assigned to the above):
· antitetanus serum 1500-3000 IU subcutaneously to reduce intoxication when the burn wound is contaminated;
· non-steroidal anti-inflammatory drugs - diclofenac 50 mg orally 2-3 times a day before meals, course 7-10 days (UD - C);
· GCS (dexamethasone 0.4%) sub 0.5 ml daily/every other day (not earlier than 5-7 days - according to indications, not in the acute phase triamcinolone 4% 0.5 ml sub 1 time). For anti-inflammatory, anti-edematous, anti-allergic, anti-exudative purposes (UD - C);
· antibacterial drugs (according to indications for severe burns in stages 1 and 2 of burn disease) enterally/parenterally - azithromycin 250 mg, 500 mg - 1 TB 2 times a day for 5-7 days, 0.5 or 0.25 ml i.v. once a day for 3 days; cefuroxime 750 mg 2 times a day for 5-7 days, ceftriaxone 1.0 IV 1 time a day for 5-7 days (LE - C).

Non-drug treatment:
· general mode II-III, table No. 15.

Surgical intervention:
Surgical interventions for eye burnsIII- IV stages:
· conjunctivotomy;
· necrectomy of the conjunctiva and cornea;
· blepharoplasty, blepharorrhaphy;
· layer-by-layer and penetrating keratoplasty, bio-coating of the cornea.

Surgical intervention provided in an inpatient setting:

Conjunctivotomy(ICD-9: 10.00, 10.10, 10.33, 10.99) :
Indications:
· pronounced swelling of the conjunctiva;
risk of limbal ischemia.
Contraindications:
general somatic status.

Necrectomy of the conjunctiva and cornea(ICD-9: 10.31, 10.41, 10.42, 10.43, 10.44, 10.49, 10.50, 10.60, 10.99, 11.49) .
Indications:
· the presence of foci of necrosis.
Contraindications:
general somatic status.

Blepharoplasty(early primary), blepharorrhaphy(ICD-9: 08.52, 08.59, 08.61, 08.62, 08.64, 08.69, 08.70, 08.71, 08.72, 08.73, 08.74, 08.89, 08.99):
Indications:
· severe burn injuries to the eyelids, with the impossibility of complete closure of the palpebral fissure;
Contraindications:
general somatic status.

Layered/penetrating keratoplasty, bio-coating of the cornea(ICD-9: 11.53, 11.59, 11.61, 11.62, 11.63, 11.64, 11.69, 11.99).
Indications:
· threat of perforation/perforation of the cornea, for therapeutic and organ-preserving purposes.
Contraindications:
general somatic status.

Further management:
· for mild burns, outpatient treatment under the supervision of an outpatient ophthalmologist;
· after the end of inpatient treatment, the patient is registered with an ophthalmologist at his place of residence (up to 1 year) with necessary recommendations(volume and frequency of clinical examinations).
· reconstructive surgery (not earlier than a year after the injury) - plastic surgery of the eyelids, conjunctival cavity, keratoprosthesis, keratoplasty.

Indicators of treatment effectiveness:
· relief of the inflammatory process;
Complete epithelization of the cornea;
· restoration of corneal transparency;
· increased visual functions;
· absence of cicatricial changes in the eyelid and conjunctiva;
· absence of secondary complications;
· formation of a vascularized corneal cataract.

Drugs ( active ingredients), used in the treatment

Azithromycin

Atropine

Boric acid

Brinzolamide

Dexamethasone

Dexpanthenol

Diclofenac

Dorzolamide

Ketorolac

Citric acid

Lactic acid

Sodium hydrocarbonate

Oxybuprocaine

Ofloxacin

Proxymetacaine

Antitetanus serum (Serum tetanus)

Timolol

Tobramycin

Tropicamide

Acetic acid

Phenylephrine

Chloramphenicol

Ceftriaxone

Cefuroxime

Cyclopentolate

Ciprofloxacin

Hospitalization

Indications for hospitalization indicating the type of hospitalization:

Indications for emergency hospitalization:
· burns of the eyes and its appendages of moderate or greater severity.
Indications for planned hospitalization: No

Information

Sources and literature

1. Minutes of meetings of the Expert Council of the RCHR of the Ministry of Health of the Republic of Kazakhstan, 2015
   1. List of used literature (valid research references to the listed sources in the text of the protocol are required): 1) Eye diseases: textbook / Under. ed. V.G. Kopaeva. – M.: Medicine, 2002. – 560 p. 2) Dzhaliashvili O.A., Gorban A.I. First aid for acute diseases and eye damage. – 2nd ed., revised. and additional – St. Petersburg: Hippocrates, 1999. – 368 p. 3) Puchkovskaya N.A., Yakimenko S.A., Nepomnyashchaya V.M. Eye burns. – M.: Medicine, 2001. – 272 p. 4) Ophthalmology: national leadership/Ed. S.E. Avetisova, E.A. Egorova, L.K. Moshetova, V.V. Neroeva, Kh.P. Takhchidi. – M.: GEOTAR-Media, 2008. – 944 p. 5) Egorov E.A., Alekseev V.N., Astakhov Yu.S., Brzhesky V.V., Brovkina A.F., et al. Rational pharmacotherapy in ophthalmology: a guide for practicing doctors / Under the general. ed. E.A. Egorova. – M.: Litterra, 2004. – 954 p. 6) Atkov O.Yu., Leonova E.S. Patient management plans “Ophthalmology” Evidence-based medicine, GEOTAR - Media, Moscow, 2011, pp. 83-99. 7) Guideline: Work Loss Data Institute. Eye. Encinitas (CA): Work Loss Data Institute; 2010. Various p. 8) Egorova E.V. et al. Technology of surgical interventions for extensive post-traumatic defects and deformations in the eyelid area \\ Mater. 111 Euro-Asian Conf. in ophthalmic surgery. – 2003, Ekaterinburg. - With. 33

Information

List of protocol developers with qualification information:

1) Isergepova Botagoz Iskakovna - candidate medical sciences, Head of the Department of Management of Scientific and Innovative Research of JSC “Kazakh Research Institute of Eye Diseases”.
2) Makhambetov Dastan Zhakenovich - ophthalmologist of the first category, JSC “Kazakh Research Institute of Eye Diseases”.
3) Mukhamedzhanova Gulnara Kenesovna - Candidate of Medical Sciences, assistant of the Department of Ophthalmology of the RSE at the RSE "Kazakh National Medical University them. Asfendiyarova S.D.”
4) Zhusupova Gulnara Darigerovna - candidate of medical sciences, associate professor of the department of JSC "Astana Medical University".

Disclosure of no conflict of interest: No

Reviewer: Shusterov Yuri Arkadyevich - Doctor of Medical Sciences, Professor, RSE at Karaganda State Medical University, Head of the Department of Ophthalmology.

Indication of the conditions for reviewing the protocol:
Review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

Attached files

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15-10-2012, 06:52

Description

SYNONYMS

Chemical, thermal, radiation damage eye.

ICD-10 CODE

T26.0. Thermal burn of the 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 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.

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

CLASSIFICATION

• I degree- hyperemia of various parts of the conjunctiva and limbus, 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 of the inflammatory process in the 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 in case of consequences of thermal burns, it is recommended to carry 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% boric acid solution, 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, once a day, Belvidon 200-400 ml at night by drip (up to 8 days after injury), or a 5% dextrose solution with ascorbic acid 2.0 g in a volume of 200-400 ml, or 4-10% dextran solution [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

At severe conditions and in the 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 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 of stage III 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 KE 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.

Main features

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.
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 are the types of eyelid diseases in humans and what drops should be used is indicated in this

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 can be the symptoms of eye conjunctivitis in children, you can see
3. Level up intraocular 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, are described in great detail in this

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– a chemical burn that affected other parts of the eye;
• T26.9- a chemical burn that affected the deep parts of the eyeball.

First aid

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 promote the death of 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.

Local anesthetics are used in the form of drops. They help reduce the intensity of pain.

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:

Group of drugs:	Name:
Glucocorticosteroids:	Prednisolone, Hydrocortisone in ointment form.
Antibiotics:	Tetracycline, Erythromycin ointment
Antiseptics:	Sodium chloride, Potassium permanganate.
Anesthetics:	Dicaine solution.
Preparations based on human tears:	Visoptic, Vizin.
Drugs that reduce the manifestations of intraocular hypertension:	Acetazolamide, Timolol.
Medicines that accelerate regenerative processes in cells:	Solcoseryl, Taurine.

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. , like other medications, describes in detail the dosage and frequency of use. Carefully follow the rules for using any medications!

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 the information in the link will help you understand.
• bury in eyeballs Taurine or any other drops 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.

Video shows 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 use them correctly 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.

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

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

List of symptoms:

1. Sharp pain in the 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. Increased intraocular 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 during a 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. An ophthalmologist determines the degree of burn, performs diagnostic procedures and selects adequate 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, you should not apply creams or other cosmetics to the skin.

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 are prescribed to relieve the inflammatory process. They promote the death of 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.

Local anesthetics are used in the form of drops. They help reduce the intensity of pain.

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 signs of 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” the development of irreversible changes in the 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 carry out the 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 the skin, there is a possibility of developing blepharitis and other inflammatory diseases. 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.

okulist.online

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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