Alkali Injury

Alkali Burn 

  • Alkaline compounds cause saponification of the fatty acids in cell membranes, which penetrates the ocular surface epithelium as well as deeper cellular structures.
  • Corneal and conjunctival epithelium, goblet cells, stromal keratocytes, corneal extracellular matrix, blood vessels, ciliary body and trabecular meshwork may be damaged.

Clinical features:

  • Immediate rise in the pH following alkaline solution exposure to eye.
  • Symptoms: ocular pain, lacrimation, blepharospasm.
  • Signs:
    • In mild cases: epithelial erosion, mild corneal haze and conjunctival injection.
    • In moderate cases: cornea may opacify with slight ischemia of limbus.
    • In severe cases: significant ischemia of the sclera, avascularity of the limbus, blanching of conjunctiva and severe corneal haze.

Complications:

  • Eyelid scarring
  • Corneal opacification, severe dry eye, corneal ulcer, perforation with potential secondary intraocular infection
  • Conjunctival scarring, symblepharon or ankyloblepharon
  • Aqueous dynamic changes with increased or decreased intraocular pressure
  • Cataract and phthisis bulbi

Management:

  • Immediate irrigation of eye until the pH of the cul-de-sac has returned to neutrality. (pH= 7.0)
  • Remove foreign bodies and sweep fornices.
  • Cycloplegic drops.
  • Topical prophylactic broad-spectrum antibiotics.
  • Analgesic.
  • Topical steroid for I week to decrease the inflammatory response.
  • Control of intraocular pressure.
  • Insertion of methymethacrylate ring into cul-de-sac might prevent symblepharon and conjunctival fibrosis.
  • Consider doxycycline for its collagenase inhibitor effect.
  • Vitamin C 2 gram qid to promote collagen synthesis.
  • During re-epithelialization phase:
    • Intense lubrication with preservative free tear is essential
    • Soft contact lens maybe helpful
    • Patching or temporary tarsorraphy
    • Surgical treatment:
      • Limbal stem cell transplantation with or without amnioniotic membrane
      • Conjunctival graft
      • Corneal transplantation