Current Concepts and Management of Severely Traumatized Tissues in the Inner Coatings (the Anterior Segment: Anterior Chamber Structures, the Iris, and the Lens) of the Globe: Non-mechanical Injuries

  • Ugur Acar
  • Atilla Bayer


Chemical agents that are often found in the home or workplace can cause severe ocular injuries. The proportion of ocular burns among eye injuries ranges between 7 and 18 % (Merle et al. 2008). Most (84 %) are chemical burns, while thermal burns represent 16 % of ocular burn cases. Approximately 15–20 % of facial burn cases have a secondary ocular injury. Burns are not age or gender specific, but younger age groups and males even in children appear to be more at risk (Acar et al. 2011). These groups may be more exposed to/engaged in situations/vocations with a high risk for ocular injury. Chemical injuries represent 11.5–22.1 % of all ocular traumas (Clare et al. 2012). They may occur under diverse circumstances and in various locations such as in the workplace, at home, or in school and may lead to significant loss of vision and even blindness as a result of devastating and irreversible anterior segment damages (Trudo and Rimm 2003; Schrage and Kuhn 2008). Most of the chemical injuries are limited to the superficial cornea and conjunctiva (see Chap.  3) due to the presence of a fast eyelid reflex and/or the Bell phenomenon. In addition, the injured patient usually washes his/her eyes with water by themselves or with the help of another person. In rare instances, serious injuries may have a worse prognosis, involving even unilateral or bilateral blindness. The most crucial factors in determining the visual outcome involve the contact time of the agent with the eye and the characteristics of the chemical agent such as volume, concentration, pH, and the transition rate from the cornea. Alkaline chemicals, which can penetrate the eye more easily compared to acid chemicals, can cause more damage to the iris, ciliary body, and lens.


Ocular Surface Macular Hole Ciliary Body Cataract Formation Lens Opacity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Acar U, Tok OY, Acar DE, et al. A new ocular trauma score in pediatric penetrating eye injuries. Eye (Lond). 2011;25(3):370–4.CrossRefGoogle Scholar
  2. Bae EJ, Hong IH, Park SP, et al. Overview of ocular complications in patients with electrical burns: an analysis of 102 cases across a 7-year period. Burns. 2013;39(7):1380–5.CrossRefPubMedGoogle Scholar
  3. Barkana Y, Belkin M, Kuhn F. Electromagnetic trauma. In: Kuhn F, editor. Ocular traumatology. New York: Springer; 2008. p. 501–12.CrossRefGoogle Scholar
  4. Boozalis GT, Purdue GF, Hunt JL, McCulley JP. Ocular changes from electrical burn injuries. A literature review and report of cases. J Burn Care Rehabil. 1991;12(5):458–62.CrossRefPubMedGoogle Scholar
  5. Clare G, Suleman H, Bunce C, Dua H. Amniotic membrane transplantation for acute ocular burns. Cochrane Database Syst Rev. 2012;(9):CD009379.Google Scholar
  6. Choplin NT. Glaucoma associated with ocular trauma. In: Thach AB, editor. Ophthalmic care of the combat casualty. Washington, DC: Storming Media; 2003. p. 185–94.Google Scholar
  7. Donshik PC, Berman MB, Dohlman CH, et al. The effect of topical corticosteroids on corneal ulceration in alkali-burned corneas. Arch Ophthalmol. 1978;96:2117–20.CrossRefPubMedGoogle Scholar
  8. Kuckelkorn R, Makropoulos W, Kottek A, Reim M. Retrospective study of severe alkali burns of the eyes. Klin Monbl Augenheilkd. 1993;203(6):397–402.CrossRefPubMedGoogle Scholar
  9. Kuckelkorn R, Kottek A, Schrage N, Reim M. Poor prognosis of severe chemical and thermal eye burns: the need for adequate emergency care and primary prevention. Int Arch Occup Environ Health. 1995;67(4):281–4.CrossRefPubMedGoogle Scholar
  10. Kuhn F, Morris R, Witherspoon CD, et al. A standardized classification of ocular trauma. Ophthalmology. 1996;103(2):240–3.CrossRefPubMedGoogle Scholar
  11. Matelis KH, Congdon N. Glaucoma. In: Kuhn F, Pieramici DJ, editors. Ocular trauma principles and practice. New York: Thieme; 2002. p. 169–79.Google Scholar
  12. McCulley JP. Chemical injuries. In: Smolin G, Thoft RA, editors. The cornea: scientific foundation and clinical practice. Little, Brown & Co: Boston; 1987. p. 527–42.Google Scholar
  13. Merle H, Gerard M, Schrage N. Ocular burns. J Fr Ophtalmol. 2008;31:723–34.CrossRefPubMedGoogle Scholar
  14. Mester V, Kuhn F. Lens. In: Kuhn F, Pieramici DJ, editors. Ocular trauma, principles and practice. New York: Thieme; 2002. p. 180–96.Google Scholar
  15. Mutlu FM, Duman H, Cil Y. Early-onset unilateral electric cataract: a rare clinical entity. J Burn Care Rehabil. 2004;25(4):363–5.CrossRefPubMedGoogle Scholar
  16. Pasternak J. Trauma of the crystalline lens. In: Thach AB, editor. Ophthalmic care of the combat casualty. Washington, DC: Storming Media; 2003. p. 171–84.Google Scholar
  17. Paterson CA, Pfister RR. Intraocular pressure changes after alkali burns. Arch Ophthalmol. 1974;91:211–8.CrossRefPubMedGoogle Scholar
  18. Schrage N, Kuhn F. Chemical injuries. In: Kuhn F, editor. Ocular traumatology. New York: Springer; 2008. p. 487–500.CrossRefGoogle Scholar
  19. Stein MR, Naidoff MA, Dawson CR. Intraocular pressure response to experimental alkali burns. Am J Ophthalmol. 1973;75:99–109.CrossRefPubMedGoogle Scholar
  20. Trudo Jr EW, Rimm W. Chemical injuries of the eye. In: Thach AB, editor. Ophthalmic care of the combat casualty. Washington DC: Storming Media; 2003. p. 115–35.Google Scholar
  21. Wagoner MD, Kenyon KR, Gipson IK. Polymorphonuclear neutrophils delay corneal epithelial wound healing in vitro. Invest Ophthalmol Vis Sci. 1984;25:1217–20.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  1. 1.Department of OphthalmologyHacettepe University, Faculty of MedicineAnkaraTurkey
  2. 2.Department of OphthalmologyWorld Eye HospitalAnkaraTurkey

Personalised recommendations