Definition

Burns can affect the eyes, particularly the cornea. Based on their cause, these burns are categorized into chemical burns and thermal burns. Chemical burns typically result from strong acidic or alkaline substances splashing into the eyes, while thermal burns are caused by heat. Chemical burns are more prevalent than thermal burns.

Causes

Chemical burns are commonly caused by strong acidic or alkaline substances, which can be found in household products such as pipe or oven cleaners, detergents, bleach, or ammonia. Other sources include fertilizers, industrial acids, alkaline solutions, lime, and cement. These burns generally occur accidentally through splashing, spraying, or rubbing the eyes.

Alkali chemical burns are usually more severe than acidic chemical burns due to the propensity of bases to adhere to fats, which constitute the primary protective layer of the eyes. Additionally, tissue damaged by alkali substances will release substances that further degrade proteins, exacerbating the damage. Conversely, acids cause protein denaturation, leading to coagulation that limits deeper tissue penetration.

Thermal burns can result from everyday objects like cooking oil, e-cigarette explosions, electric arcs, or scorch wounds. Fireworks and firecrackers can cause both chemical and thermal burns simultaneously.

Risk Factor

Chemical and thermal burns are more likely to occur in young men and children aged 1-2 years. Young men often encounter these substances during work at home, in factories, or while smoking. Children might come into contact with chemicals and inadvertently rub their eyes.

Symptoms

Common symptoms of eye burns include severe pain, excessive tearing, stiff eyelid muscles, and reduced visual acuity. These symptoms typically arise after exposure to chemicals or heat, or after rubbing the eyes.

Diagnosis

Doctors diagnose eye burns based on patient medical history. They will inquire about the incident's history and chronology. For chemical burns, the doctor will irrigate the eye with IV fluid while monitoring the eye's surface acidity with litmus paper. Once the pH is normalized, the doctor will examine the eye to determine if it is ruptured. If a rupture is present, surgical referral is necessary. If there is no rupture, the doctor will inspect for foreign objects or tissue residues in the eye using dyes to highlight corneal tissue damage. A slit lamp examination will be conducted to detect internal eye damage. External examinations, such as visual acuity and intraocular pressure assessments, will also be performed.

For thermal burns, the eye will be irrigated with IV fluid prior to further examination. The doctor will ask about the trauma incident, and if an explosion was involved, they will check for small particles embedded in or penetrating the eye. Additional examinations to detect trauma in other body parts are also essential to prevent complications.

Management

Initial management of eye burns can be done independently before seeking emergency medical attention. The primary first aid measure is to flush the eyes with clean water to neutralize the chemicals or heat. It is crucial not to use acidic or alkaline chemicals for neutralization, as this can cause further damage.

Here are the steps of eye flushing:

• Fill a basin with cold, clean water.
• Submerge your face into the basin, ensuring your eyes are fully immersed.
• Open and close your eyes repeatedly to ensure the water reaches all parts of the eye surface.
• Continue this process for 20-30 minutes while en route to the emergency room. If using a basin is not feasible, the top priority is to flush the eyes with clean running water.
• Alternatively, have someone assist you by running clean water from a small hose over your eyes.
• Direct the water flow from the nose outward.
• While the water is running, blink and move your eyes in all directions to ensure complete surface flushing.
• Continue this method for 20-30 minutes or longer if necessary.

In the emergency room, the doctor will usually treat the patients by flushing their eyes with IV fluid after administering a local anesthetic. They may use a tool to hold the eyes open. The doctor will typically flush the eyes for 30 minutes using 1-3 liters of water until the acidity level is neutralized, as measured with litmus paper. They will also ensure that the entire eye surface, including the eyelids, is thoroughly rinsed.

After neutralizing the acidity, the doctor may prescribe medications. Antibiotics are necessary to prevent infections due to the damaged eye surface. Visual muscle relaxants can alleviate pain, and artificial tear drops can help moisturize the eye surface and reduce discomfort. Steroids might be prescribed to decrease inflammatory reactions, such as swelling and further corneal damage. These medications must be prescribed by a doctor, as excessive use of certain drugs can be harmful.

In severe cases, the ER doctor may refer you to an eye specialist for surgery, which can be performed to prevent further damage or to facilitate healing.

Complications

Several complications can arise from eye burns. Severe burns may lead to glaucoma due to disrupted fluid flow in the front of the eye. Tissue damage can result in dry eyes from reduced tear production. It can also affect the eyelids and conjunctiva, the clear layer lining the eyeball and inner eyelid.

Prevention

Preventing chemical and thermal burns in everyday situations is challenging, but they can be mitigated in high-risk environments. Wearing protective eyewear when working with chemicals and metals can significantly reduce the risk of eye injuries.

When to See a Doctor?

Seek immediate medical attention if you experience any of the following symptoms after exposure to heat or chemicals:

• Persistent double vision or vision loss that does not improve with blinking
• Eye pain
• Discomfort when looking at light sources
• Sensation of a foreign body in the eye
• Red, swollen, twitching, watery, or purulent eyes
• Symptoms lasting more than 24 hours
• Symptoms that occur frequently or worsen

Looking for more information about other diseases? Click here!