Burns of eyes
Burns of eyes – sharp traumatic injury of an eyeball, the protective and additional device of an eye by aggressive chemicals or physical factors. The burn of an eye is followed by sharp pain, sight falling, dacryagogue, hypostasis a century and conjunctivas, emergence of bubbles on skin. Diagnosis of a burn of an eye is carried out taking into account data of the anamnesis and external examination; in addition can include measurement of intraocular pressure, biomicroscopy, an oftalmoskopiya. The burn of an eye demands immediate first-aid treatment – plentiful washing of a conjunctival cavity, instillation of solution of anesthetic, a mortgaging for an eyelid of antibacterial ointment and delivery of the patient in a hospital where the issue of further tactics is resolved.
Burns of eyes
Burns of eyes make from 5 to 15% of all eye injuries in ophthalmology. 65-75% of cases come from them on production, the others – in life. The biggest group of burns (60-80%) is made by injuries of eyes by chemical agents (alkalis, acids, lime, etc.); thermal burns a flame, steam, boiled water, particles of the melted metal go the following on the frequency of emergence. Less often burns of eyes develop under the influence of infrared beams, ultraviolet, ionizing radiation. First of all at a burn of an eye skin a century, a conjunctiva suffers, however travmatization can be also exposed slezootvodyashchy ways, a cornea, deep structures of forward and back departments of an eye.
Reasons of burns of eyes
More than 40% of chemical burns are caused by hit in an eye of various alkalis (ammonia, the caustic soda, extinguished lime, ethyl alcohol, caustic potassium, etc.), another 10% - contact with the concentrated acids (acetic, sulfuric, salt, etc.). In other cases burns of eyes are caused by careless handling of construction paints and varnishes, household aerosols, means of individual self-defense (barrels, gas guns), paint for coloring of eyelashes, poisonous plants (a cow-parsnip, etc.), herbicides, insecticides and so forth. The wrong instillation in eyes of the solutions which are not intended for these purposes (drops for ears, spirit tinctures) can also lead to a burn.
At hit the kollikvatsionny necrosis which is characterized by hydrolysis of cellular membranes, death of cages, enzymatic destruction of fabrics develops in eyes of alkalis. Depth and the sizes of the formed necrosis usually exceed the size of a zone of direct contact with the aggressive agent therefore authentic data on weight of damage can be received only later 48-72 h.
Influence approximately acid leads to a coagulative necrosis – a denaturation of cellular proteins and formation of a scab under which pathological changes can be expressed poorly or be absent. Further injuries of an eye at a burn are connected by acid with the inflammation caused by toxic reaction and accession of a secondary infection.
Leads impact on eyes by high-temperature agents to thermal burns – the boiling water, steam, the heated fat, a flame, particles of the melted metal, incendiary and flammable mixes (petards, fireworks, etc.). Thermal injuries of eyes are often combined with burns of integuments. The nature of defeat at a thermal burn of eyes - a coagulative necrosis.
Damages of the device of an eye by infrared or ultraviolet rays, ionizing radiation belong to beam burns. Burns of eyes from infrared beams occur at metallurgists, people working with laser sources, etc. In this case there is a defeat of appendages of an eye and forward department of an eyeball more often; penetration of infrared beams on an eye bottom with development of hypostasis and the subsequent dystrophic changes of a retina is in rare instances possible. Damage of eyes ionizing radiation usually happens at contact with radioactive dust or other sources of radiation. The burns of eyes connected with impact of a sunlight can arise in conditions when ultraviolet rays poorly are late the atmosphere, for example, in mountains: such damage of eyes is called a snow oftalmiya (a mountain or snow blindness). Fotooftalmiya, connected with the radiation of electrosources (electric welding, use of quartz lamps, etc.), carry the name of an elektrooftalmiya.
Classification of burns of eyes
Thus, taking into account an etiology, burns of eyes can be chemical, thermal, beam and combined.
On depth of the damaging impact on fabrics distinguish four degrees of burns of eyes:
The I degree (easy) is characterized by hyperaemia of skin of a century and a conjunctiva; hypostasis and superficial erosion of a cornea which are defined when conducting instillyatsionny test with flyuorestseiny. As criterion of easy degree of a burn of an eye serves complete disappearance of the called defeats.
The II degree (average weight) is shown by damage of blankets of skin a century, hypostasis and a superficial necrosis of a conjunctiva, defeat of an epithelium and stroma of a cornea in view of what the surface of a cornea becomes uneven and grayish and muddy. On skin a century burn bubbles are formed.
The III degree (heavy) is characterized by a necrosis of a conjunctiva and subjects of fabrics – centuries, a cartilage, skler. At a heavy burn of an eye the conjunctiva takes a form of a yellowish or grayish-white scab with an opaque surface. The cornea becomes muddy, its surface – dry. Development of an iridotsiklit and a cataract is possible. Rejection of a scab is followed by scarring of defects mucous eyes and corneas. Damage affects no more than 50% of a surface of an eyeball.
The IV degree (especially heavy) proceeds with a deep necrosis or a carbonization not only conjunctivas, but also skler. The cornea, owing to defeat on all depth, becomes similar to an opaque porcelain-white plate. Development of heavy uveit, a cataract and secondary glaucoma is typical; perforation of a cornea is possible.
Depending on localization distinguish burns a century and okologlaznichny area; burns of a conjunctival bag and cornea; the burns causing a gap and destruction of an eyeball; burns of other parts and additional device of an eye.
Development of patomorfologichesky changes at burns of eyes allows to allocate 4 stages of a burn trauma:
The first stage of a burn of an eye lasts up to 2 days. During this period promptly accrues fabrics, hydration and swelling of a cornea develops, there is a dissociation (disintegration) proteinaceous complexes.
During the second stage of a burn of an eye proceeding from 2nd to 18 days fibrinoidny swelling of a cornea and the expressed trophic frustration develops.
The third stage of a burn of an eye is characterized by trophic violations, a hypoxia of fabrics and a neovaskulyarizatsiy cornea. This process takes 2-3 months.
The fourth stage of a burn of an eye can last up to several years. At this time there are scarring processes, synthesis of collagenic proteins cornea cages amplifies.
Assessment of depth and extent of defeat during the first hours after a burn of an eye is very difficult. Weight of a burn of eyes depends on concentration and time of influence of the damaging factor, and also speed of completeness of first-aid treatment. The forecast for safety of visual function at heavy and especially heavy burns of eyes adverse.
Eye burn symptoms
At a burn of easy degree there is sharp affected eye pain, reddening and moderate hypostasis of fabrics, feeling of hit of a foreign matter, a sight zatumanivaniye. At influence of thermal agents there is a reflex smykaniye of an eye crack therefore defeat can be limited only to fabrics a century. In case of contact with a flame eyelashes burn down, the wrong growth of eyelashes - can be noted further.
Heavy burns of an eye are led to a necrosis of a conjunctiva and an exposure by skler. In this case ulcer defect which cicatrizes subsequently, forming unions between a century and an eyeball is formed. At burns of a cornea dacryagogue, a photophobia, is noted; in hard cases – neurotrophic keratit, turbidity of a cornea. Depending on weight of a burn of an eye of change of visual function can be shown by insignificant decrease in sight or its total loss.
At defeat of tissues of iris and tsiliarny body develop Irit and iridotsiklit. At heavy burns of eyes there is a turbidity of a vitreous body and a crystalline lens, the vascular cover and a retina are damaged. As a complication of deep burns of eyes serves development of secondary glaucoma. In case of infection of tissues of eye arise endoftalmit and panoftalmit. Deep chemical burns lead to a perforation of a cornea and death of an eye.
Burns of eyes can be combined with burns of other parts of the face and bodies.
Diagnosis of a burn of eyes
Burns of eyes are diagnosed according to the anamnesis and a clinical picture. At identification of burn injury of an eye immediate rendering emergency aid therefore special ophthalmologic researches in the sharp period are not conducted is necessary.
Further, for damage rate assessment, perform external examination of eyes by means of vekopodjemnik, visual acuity definition, measurement of intraocular pressure, an oftalmoskopiya, biomicroscopy with coloring flyuorestseiny for detection of ulcer defects of a cornea and other researches on indications.
Treatment of burns of eyes
First aid at burns of eyes has to be given on the place; further hospitalization of the victim in an ophthalmologic hospital is necessary.
Urgent measures at burns of eyes are plentiful jet washing of a conjunctival cavity physiological solution or water. Independent use of neutralized solutions is not recommended in view of the possible not predicted action of products of reaction to the damaged fabrics. During the first hours after a burn of an eye washing of plaintive ways, removal of the taken root foreign matters from a conjunctiva and a cornea is made. In a conjunctival cavity dig in drops or put ointments of mestnoanesteziruyushchy action. Introduction is shown to the victim of antitetanic serum.
In a hospital to patients with a burn of eyes instillations in an eye of tsitoplegichesky means are appointed (atropine, a skopolamin): they allow to reduce pain and probability of formation of solderings. For the purpose of prevention of infection the eye ointments and drops containing antibiotics (, , ciprofloxacin), are applied by NPVS. At burns of eyes use of substitutes of plaintive liquid is expedient. Intramuscular and parabulbarny injections of antioxidants (metiletilpiridinol) are appointed. For stimulation of regeneration of a cornea for an eyelid put eye gels (dialyzate from blood of dairy calfs or ). At the raised VGD local hypotensive medicines are appointed (, ). At heavy degrees of burns of eyes application of glucocorticoids (dexamethasone, a beta metazone, etc.) in the form of parabulbarny or subconjunctival injections is shown.
Surgical tactics at burns of eyes is very variable and is defined by character and extent of defeat of eye fabrics. At hit of chemical reagents in the forward camera of an eye carrying out a paratsentez of a cornea and removal of the got substances is necessary.
At threat of loss of an eye surgeries on centuries or an eyeball - a nekrektomiya of a conjunctiva and a cornea, a vitrektomiya, plasticity of a conjunctival cavity, an early keratoplasty, etc. can be carried out to early terms after a burn of an eye.
Further performance of plastic surgeries on centuries - correction of a zavorot or eversion of a century, elimination of a ptoz, restoration of eyelashes can be required at a trikhiaza, surgical treatment of a postburn cataract and so forth. At formation of hems of a cornea in the delayed period the layer-by-layer or through keratoplasty is made; at development of secondary glaucoma - antiglaukomatozny operations.
Forecast and prevention of burns of eyes
The forecast at burns of eyes is defined by character and weight of a trauma, terms of rendering the specialized help, correctness of performing medicamentous therapy. As an outcome of heavy burns of eyes, as a rule, serves , formation of a cataract, a zarashcheniye of a conjunctival cavity, an eyeball atrophy, considerable extents of decrease in visual function.
By estimates of experts, about 90% of cases of a burn of eyes it is possible to warn. Therefore prevention of burns of eyes, first of all, demands observance of safety measures at the treatment of chemical and flammable substances, household chemicals; uses of goggles with light filters. Patients with burns of eyes need observation of the ophthalmologist within not less than 1 year after a trauma.