Corneal Burn
Basics
Description
Description
- Inappropriate exposure of cornea to chemicals, heat, cold, electrical, or radiant energy causing damage to the cornea and often extending to adjacent structures
- Severity of injury related to duration of exposure, type of agent, anion concentration, pH level of solution
- Alkalis:
- Cause immediate rise in pH level
- Highly soluble in lipids, so rapidly penetrate the eye, causing severe corneal injury and continue to penetrate over time if no intervention undertaken
- Penetration can occur in <1 min
- Exception: Calcium alkalis penetrate relatively poorly, secondary to soap formation; can cause corneal opacification, so may appear worse but actually have better prognosis than other alkali burns
- Acids:
- Immediately coagulate proteins of corneal epithelium
- Cause opacification
- Coagulation produces barrier to deeper penetration
- Exception: Lipophilicity of hydrofluoric (HF) acid causes it to act similar to a base with more rapid penetration
- Thermal burns:
- Affect eyelids more than globe due to reflex blinking and Bell phenomenon (eyes roll up and outward)
- Cause direct injury to cornea
- Damage primarily depends on duration and intensity of heat
- Electrical injury:
- Occurs with current flow through head, with input at or near eye
- Radiation injury:
- Due to ultraviolet light exposure to cornea
- Often bilateral
- Symptoms usually increase 6–12 hr after exposure
Etiology
Etiology
- Alkalis:
- Ammonia:
- Fertilizer, refrigerant, household ammonia, cleansing agents
- Potassium hydroxide:
- Caustic potash
- Magnesium hydroxide:
- Sparklers, flares, fireworks
- Lye: NaOH:
- Caustic soda, drain cleaners
- Lime: CaOH2 or MgOH2:
- Fresh lime, quicklime, calcium hydrate, slaked lime, hydrated lime, plaster, mortar, cement, whitewash
- Nonspecific alkali:
- Motor vehicle airbag on inflation releases alkali
- Detergent pods
- Ammonia:
- Acids:
- Sulfuric acid: H2SO4:
- Car battery acid, toilet cleaner
- Sulfurous acid: H2SO3:
- Preservatives (fruit and vegetable)
- Acetic acid: CH3CO2H:
- Vinegar
- Sulfuric acid: H2SO4:
- Bleach
- Refrigerants:
- HF acid:
- Etching silicon/glass
- Cleaning brick
- Electropolishing metals
- Control of fermentation in breweries
- Commercial/household rust removal
- HF acid:
- Thermal:
- Hot liquids, molten metal
- Flames
- Hot smoke/gases
- Flash burn
- Steam
- Cigarette burns
- Radiation:
- Sun lamps
- Tanning booths
- High-altitude sunlight
- Reflection off snow/water
- Arc welding
Pediatric Considerations
Consider child abuse or neglect
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Citation
Schaider, Jeffrey J., et al., editors. "Corneal Burn." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307056/all/Corneal_Burn.
Corneal Burn. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307056/all/Corneal_Burn. Accessed December 5, 2024.
Corneal Burn. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307056/all/Corneal_Burn
Corneal Burn [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307056/all/Corneal_Burn.
* Article titles in AMA citation format should be in sentence-case
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