Chemical Injuries to the Eye

Chemical Injuries to the Eye
Teresa Spohnholz
Ophthalmic Medical Technology Student College of Health Professions
University of Arkansas for Medical Sciences

A 70 year old male presents in 2010 with mild epiphora, foreign body sensation, and some discomfort to his right eye due to an alkali burn when he was fifteen years old. On exam his best corrected visual acuity was count fingers with eccentric viewing at one foot in the right eye and 20/20 in the left eye. Intraocular pressure readings were 28mm of Hg in the right eye and 20mm of Hg in the left eye. In addition to his alkali burn, his past ocular history was remarkable in the right eye for three failed penetrating keratoplasties (PK), cataract extraction with intraocular lens, and a glaucoma shunt. Slit lamp examination revealed in the right eye a failed graft with complete pannus, corneal scarring with large central band keratopathy, neovascularization, and a tube shunt in the anterior chamber. All structures in the left eye were noted as normal. Topical eye medications being used in the right eye were two drops of prednisolone as needed, one drop of timolol daily, and erythromycin ointment to be applied four times a day.

After several follow up appointments and worsening vision to hand motion OD, the patient underwent a repeat PK and concurrent conjunctival-limbal autograft from the left eye to provide stem cells for the right eye. His post-operative course was notable for persistent epithelial defect, presumably due to insufficient stem cells. This is a typical scenario for patients with chemical eye injuries. This paper will address the clinical features and management of such injuries.