Elsevier

Ophthalmology

Volume 113, Issue 6, June 2006, Pages 960-961.e1
Ophthalmology

Original Article
Severe Ocular Injury Resulting from Chuna Packets

Presented at: American Academy of Ophthalmology Annual Meeting, October, 2004; New Orleans, Louisiana.
https://doi.org/10.1016/j.ophtha.2006.01.042Get rights and content

Objective

To describe a mechanism of severe ocular alkali burns occurring as a result of bursting of chuna packets (edible calcium hydroxide paste), a popular additive to chewing tobacco in India.

Design

Retrospective case series.

Participants

Twenty-one patients (25 eyes) who experienced ocular burns as a result of bursting of chuna packets.

Intervention

Patients were treated medically or with 1 or more of the following surgeries: symblepharon release, amniotic membrane grafting, allograft or autograft stem cell transplantation, or both, and large diameter lamellar keratoplasty.

Main Outcome Measures

The main outcome measures were time interval between the injury and presentation, presenting visual acuity, grade of injury, management (medical therapy or surgical intervention), and final visual outcome at the last follow-up.

Results

The average age at time of injury was 8.4±5.5 years. The median visual acuity at presentation was light perception with projection. The ocular burns were grade 4 in 23 eyes. Eight of 25 eyes were treated medically, and the rest underwent 1 or more surgeries in the form of symblepharon release (n = 6), amniotic membrane grafting (n = 3), allograft or autograft stem cell transplantation (n = 6), and large diameter lamellar keratoplasty (n = 6). At the final follow-up (mean, 637±592 days), median visual acuity was 1/60.

Conclusions

Bursting of chuna packets can cause severe ocular alkali burns in children. These patients carry a poor visual prognosis with both medical and surgical therapy.

Section snippets

Patients and Methods

In this retrospective case series, chart review of patients who were treated at the Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India, between March, 1999, and July, 2003, with ocular alkali burns resulting from bursting of chuna packets was conducted (Table 1 [available at http://aaojournal.org]). The grading of the ocular burns was carried out on the basis of the modified Roper-Hall classification.3

The management of the patient depended on the stage of patient when seeking

Results

Twenty-one patients with a history of ocular burns resulting from chuna packets bursting were seen from March, 1999, through July, 2003. Of these, 4 patients had bilateral burns (Fig 2). Of the 21 patients, 17 were male and 4 were female. The mean age at time of injury was 8.4±5.5 years (range, 3.8–26.8 years). All but 1 patient were under the age of 16 years.

The time interval between injury and presentation to us was 184±247 days (range, 0–912 days). Eight (38%) patients sought treatment in

Discussion

We report 21 patients who experienced ocular alkali burns, most of them severe, resulting from bursting of chuna packets. This occurs because of the pastelike consistency of chuna. On bursting of the packets, the chuna is sprayed around and coats the cornea and conjunctiva. It also becomes lodged in the conjunctival fornices, and the calcium hydroxide continues to be exposed to the ocular surface. It can be removed by careful inspection of the eyelids after double eversion using Desmarres’

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Manuscript no. 2005-575.

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