Corneal Burn

Basics

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

Pediatric Considerations
Consider child abuse or neglect

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