Elsevier

Ophthalmology

Volume 121, Issue 1, January 2014, Pages 377-380
Ophthalmology

Original article
Demographic and Clinical Profile of Ocular Chemical Injuries in the Pediatric Age Group

Presented in part as a poster at: the Annual Meeting of the American Academy of Ophthalmology, November 10–13, 2012, Chicago, Illinois.
https://doi.org/10.1016/j.ophtha.2013.06.044Get rights and content

Objective

To review the risk factors, management, and visual outcomes of pediatric chemical eye injuries in a tertiary care hospital in North India.

Design

Retrospective hospital-based study.

Participants

Patients aged <16 years with ocular chemical burns.

Methods

Case records of patients with ocular chemical injury who presented to the Dr. Rajendra Prasad Centre for Ophthalmic Sciences were reviewed over a 5-year period.

Main Outcome Measures

Demographic profile, nature of chemical injury, complications, and visual outcomes after chemical injury.

Results

A total of 134 pediatric patients with a history of ocular chemical burns were seen between March 2006 and March 2011. The mean age of patients at the time of injury was 8.95±4.89 years (range, 1.2–15.5 years); 63.4% were male. Sixty-nine patients (51.4%) belonged to the preschool (0–5 years) age group. Bilateral chemical injuries were seen in 24 patients (17.9%). Lime (“chuna”) was the most commonly involved chemical (88, 65.6%) followed by toilet cleaner (20, 14.9%). The mean time between injury and presentation was 68.3 days (range, 1–365 days). Severe (grade 3 and 4) ocular chemical injury was seen in 94 patients (70.1%). Surgical intervention was performed in 114 eyes (85%) in the form of amniotic membrane grafting (n = 78), symblepharon release (n = 56), limbal stem cell transplantation (n = 26), and lamellar keratoplasty (n = 14). The average number of surgeries conducted per patient was 2.3 (range, 1–4). Median visual acuity at final follow-up (mean, 537±354 days) was 3/60.

Conclusions

Chemical injuries in pediatric patients are more commonly encountered in the preschool age group and are associated with severe visual loss. Alkali injury from bursting of chuna packets was the most common mode of injury in pediatric patients in our study.

Section snippets

Methods

In this retrospective chart review, case records of pediatric patients who were treated at a tertiary eye care hospital between March 2006 and March 2011 with ocular chemical burns were analyzed. The study was approved by an institutional review board and adhered to the tenets of the Declaration of Helsinki. Modified Roper-Hall classification was used for grading of ocular burns.1 The management of patients depended on the severity of ocular injury at the time of presentation. In the acute

Results

A total of 134 patients (85 [63.4%] were male) with ocular chemical injury were seen between March 2006 and March 2011. The mean age at the time of injury was 8.95±4.89 years (range, 1.2–15.5 years), with approximately half (n = 69, 51.4%) of the patients in the 0- to 5-year-old age group (Table 1). The highest male-to-female ratio was seen in the 6- to 10-year-old age group with a ratio of 3.2:1, whereas the youngest age group (0–5 years) showed a relatively lower male-to-female ratio of

Discussion

Chemical ocular burns are potentially blinding because extensive limbal ischemia impairs ocular surface healing, eventually causing corneal opacification, which is difficult to treat with conventional corneal transplantation techniques.13 Although alkalis cause more severe chemical injuries compared with acids,14, 15, 16 acidic agents such as hydrofluoric acid are known to produce severe injuries because of rapid penetration into the eye.17 Management of severe ocular chemical injuries

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      Current literature describes the epidemiology of OSCI in the context of ocular trauma [11–33], chemical injuries to all body areas [34–41], calls to poisons control centers about ocular exposures [42–44] and hospital admissions [10,45,46], general [47–50] or eye emergency department attendances due to OSCI [51–68]. This is also divided by occupational ocular injuries [69–83] or by age [84–96]. Young adult males are still most at risk of OSCI, however, other groups may be more at risk than previously thought, such as children under 5 years old [45,48].

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    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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