Thermal burn of the cornea and conjunctiva. Eye burns Treatment of burns with folk methods

15-10-2012, 06:52

Description

SYNONYMS

Chemical, thermal, radiation damage to the eyes.

ICD-10 CODE

T26.0. Thermal burn of the eyelid and periorbital region.

T26.1. Thermal burn of the cornea and conjunctival sac.

T26.2. Thermal burn leading to rupture and destruction of the eyeball.

T26.3. Thermal burns of other parts of the eye and its adnexa.

T26.4. Thermal burn of the eye and adnexa of unspecified localization.

T26.5. chemical burn eyelid and periorbital region.

T26.6. Chemical burn of the cornea and conjunctival sac.

T26.7. Chemical burn leading to rupture and destruction of the eyeball.

T26.8. Chemical burn of other parts of the eye and its adnexa.

T26.9. Chemical burn of the eye and adnexa of unspecified localization.

T90.4. Sequelae of an eye injury in the periorbital region.

CLASSIFICATION

I degree- hyperemia of various parts of the conjunctiva and the limbus zone, superficial erosion of the cornea, as well as hyperemia of the skin of the eyelids and their swelling, slight swelling.
II degree b - ischemia and superficial necrosis of the conjunctiva with the formation of easily removable whitish scabs, clouding of the cornea due to damage to the epithelium and superficial layers of the stroma, the formation of blisters on the skin of the eyelids.
III degree- necrosis of the conjunctiva and cornea to deep layers, but not more than half of the surface area of the eyeball. The color of the cornea is "matte" or "porcelain". Changes in ophthalmotonus are noted in the form of a short-term increase in IOP or hypotension. Perhaps the development of toxic cataracts and iridocyclitis.
IV degree- deep lesion, necrosis of all layers of the eyelids (up to charring). Damage and necrosis of the conjunctiva and sclera with vascular ischemia on the surface of more than half of the eyeball. The cornea is "porcelain", a tissue defect over 1/3 of the surface area is possible, in some cases perforation is possible. Secondary glaucoma and severe vascular disorders - anterior and posterior uveitis.

ETIOLOGY

Conventionally, chemical (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and radiation burns are distinguished.

CLINICAL PICTURE

Common signs of eye burns:

the progressive nature of the burn process after the cessation of exposure to the damaging agent (due to metabolic disorders in the tissues of the eye, the formation of toxic products and the occurrence of an immunological conflict due to autointoxication and autosensitization by the post-burn period);
tendency to relapse inflammatory process in choroid at various times after receiving a burn;
a tendency to the formation of synechia, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.

Stages of the burn process:

Stage I (up to 2 days) - the rapid development of necrobiosis of the affected tissues, excessive hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acid polysaccharides;
Stage II (2-18 days) - manifestation of pronounced trophic disorders due to fibrinoid swelling:
Stage III (up to 2-3 months) - trophic disorders and vascularization of the cornea due to tissue hypoxia;
Stage IV (from several months to several years) - a period of scarring, an increase in the amount of collagen proteins due to an increase in their synthesis by corneal cells.

DIAGNOSTICS

Diagnosis is based on history and clinical picture.

TREATMENT

Basic principles of treatment of eye burns:

rendering emergency care aimed at reducing the damaging effect of a burn agent on tissues;
subsequent conservative and (if necessary) surgical treatment.

When providing emergency care to the victim, it is necessary to intensively wash the conjunctival cavity with water for 10-15 minutes with the obligatory eversion of the eyelids and washing the lacrimal ducts, and thorough removal of foreign particles.

Washing is not carried out with a thermochemical burn if a penetrating wound is found!

Surgical interventions on the eyelids and eyeball in early dates carried out only for the purpose of preserving the organ. Vitrectomy of burned tissues, early primary (in the first hours and days) or delayed (after 2-3 weeks) blepharoplasty with a free skin flap or a skin flap on a vascular pedicle with a simultaneous transplantation of automucosa on the inner surface of the eyelids, arches and sclera are performed.

Planned surgical interventions on the eyelids and the eyeball with the consequences thermal burns it is recommended to carry out 12-24 months after the burn injury, since against the background of autosensitization of the body, allosensitization to the graft tissues occurs.

For severe burns, 1500-3000 IU of tetanus toxoid should be injected subcutaneously.

Treatment of stage I eye burns

Prolonged irrigation of the conjunctival cavity (within 15-30 minutes).

Chemical neutralizers are used in the first hours after the burn. In the future, the use of these drugs is impractical and may have a damaging effect on the burned tissue. For chemical neutralization, the following means are used:

alkali - 2% solution boric acid, or 5% solution citric acid, or 0.1% lactic acid solution, or 0.01% acetic acid:
acid - 2% sodium bicarbonate solution.

At severe symptoms intoxication, intravenous drip 1 time per day, belvidone, 200-400 ml at night, drip (up to 8 days after injury), or 5% dextrose solution with ascorbic acid 2.0 g in a volume of 200-400 ml, or 4-10% dextran solution [cf. they say weight 30,000-40,000], 400 ml intravenous drip.

NSAIDs

H1 receptor blockers: chloropyramine (orally 25 mg 3 times a day after meals for 7-10 days), or loratadine (orally 10 mg 1 time per day after meals for 7-10 days), or fexofenadine (orally 120-180 mg 1 time per day after meals for 7-10 days).

Antioxidants: methylethylpyridinol (1% solution of 1 ml intramuscularly or 0.5 ml parabulbarno 1 time per day, for a course of 10-15 injections).

Analgesics: metamizole sodium (50%, 1-2 ml intramuscularly for pain) or ketorolac (1 ml for pain intramuscularly).

Preparations for instillation into the conjunctival cavity

In severe conditions and early postoperative period the multiplicity of instillations can reach 6 times a day. As the inflammatory process decreases, the duration between instillations increases.

Antibacterial agents: ciprofloxacin ( eye drops 0.3%, 1-2 drops 3-6 times a day), or ofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or tobramycin 0.3% (eye drops, 1 -2 drops 3-6 times a day).

Antiseptics: picloxidine 0.05% 1 drop 2-6 times a day.

Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone ( eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisolone (eye drops 0.5%, 1-2 drops 3-6 times a day).

NSAIDs: diclofenac (orally 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (orally 25 mg 2-3 times a day after meals, course 10-14 days).

Midriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day) in combination with phenylephrine (eye drops 2 5% 2-3 times a day for 7-10 days).

Corneal regeneration stimulators: actovegin (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or solcoseryl (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or dexpanthenol (eye gel 5% for the lower eyelid 1 drop 2-3 times a day).

Surgery: sectoral conjunctivotomy, corneal paracentesis, conjunctival and cornea necrectomy, genonoplasty, corneal biocoverage, eyelid surgery, layered keratoplasty.

Treatment of stage II eye burns

Groups of drugs are added to the ongoing treatment, stimulating immune processes, improving the utilization of oxygen by the body and reducing tissue hypoxia.

fibrinolysis inhibitors: aprotinin 10 ml intravenously, for a course of 25 injections; instillation of the solution into the eye 3-4 times a day.

Immunomodulators: levamisole 150 mg 1 time per day for 3 days (2-3 courses with a break of 7 days).

Enzyme preparations: systemic enzymes 5 tablets 3 times a day 30 minutes before meals, drinking 150-200 ml of water, the course of treatment is 2-3 weeks.

Antioxidants: methylethylpyridinol (1% solution of 0.5 ml parabulbarno 1 time per day, for a course of 10-15 injections) or vitamin E (5% oil solution, inside 100 mg, 20-40 days).

Surgery: layered or penetrating keratoplasty.

Treatment of stage III eye burns

The following are added to the treatment described above.

Short-acting mydriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day).

Antihypertensive drugs: betaxolol (0.5% eye drops, twice daily) or timolol (0.5% eye drops, twice daily) or dorzolamide (2% eye drops, twice daily).

Surgery: keratoplasty according to emergency indications, antiglaucoma operations.

Treatment of stage IV eye burns

The following are added to the ongoing treatment.

Glucocorticoids: dexamethasone (parabulbarno or under the conjunctiva, 2-4 mg, for a course of 7-10 injections) or betamethasone (2 mg betamethasone disodium phosphate + 5 mg betamethasone dipropionate) parabulbarno or under the conjunctiva 1 time per week 3-4 injections. Triamcinolone 20 mg once a week 3-4 injections.

Enzyme preparations in the form of injections:

fibrinolysin [human] (400 IU parabulbarno):
collagenase 100 or 500 KE (the contents of the vial are dissolved in 0.5% procaine solution, 0.9% sodium chloride solution or water for injection). It is administered subconjunctivally (directly into the lesion: adhesion, scar, ST, etc. using electrophoresis, phonophoresis, and also applied to the skin. Before use, the patient's sensitivity is checked, for which 1 KE is injected under the conjunctiva of the diseased eye and observed for 48 hours. absence allergic reaction carry out treatment within 10 days.

Non-drug treatment

Physiotherapy, eyelid massage.

Approximate periods of incapacity for work

Depending on the severity of the lesion, they are 14-28 days. Possible disability in the event of complications, loss of vision.

Further management

Observation of an ophthalmologist at the place of residence for several months (up to 1 year). Control of ophthalmotonus, state of ST, retina. With a persistent increase in IOP and the absence of compensation on a medical regimen, antiglaucomatous surgery is possible. With the development traumatic cataract the removal of the cloudy lens is indicated.

FORECAST

Depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the victim's admission to the hospital, the correctness of the appointment of drug therapy.

Article from the book: .

Chemical burns of the organs of vision occur due to contact with aggressive chemical reagents. They lead to damage to the anterior part of the eyeball, cause unpleasant symptoms: pain, irritation, and can lead to vision problems.

Main features

An eye burn is not a disease, but pathological condition, which can be completely eliminated if you turn to an ophthalmologist in time.

List of symptoms:

Sharp pain in the eyes. But why there is pain in the eyeball when pressed, this will help to understand
Redness of the conjunctiva.
Discomfort, burning sensation, irritation.
Increased tearing.

It is difficult not to notice the chemical damage to the organ of vision. It's all about the pronounced symptoms, which gradually increase.

Substances of a chemical nature acts gradually. Once on the skin of the eyes, they cause irritation, but if you leave the burn unattended, then its manifestations will only intensify.

Aggressive reagents gradually cause damage to the skin of the eyelids and the eye. It is possible to assess the degree of the inflicted "injuries" and their severity in 2-3 days. But what are the diseases of the eyelids of the eyes in humans and what drops should be used, indicated in this

Burn classification

On the video - a description of a chemical burn of the eye:

Clinical manifestations

Damage to the surface of the skin of the eyelids.
The presence of foreign substances in the tissues of the conjunctiva. But what can be the symptoms of eye conjunctivitis in children, you can see
Increased intraocular pressure (ocular hypertension).

Abundant damage to the skin occurs upon contact with reagents. Substances irritate the mucous membrane, which leads to redness and irritation of the anterior sections of the eyeball.

Ophthalmological examination reveals particles of foreign substances, they are clearly visible during clinical examination. Conducting research helps to establish which substance led to the development of damage (acid, alkali).

Reagents act on the parts of the eyeball in a special way. Contact leads to "drying" or drying of the mucous surface and an increase in the level of intraocular pressure. But what are the symptoms in adults of increased eye pressure, is described in great detail in this

Evaluation of the totality of symptoms helps to make the correct diagnosis for the patient. The ophthalmologist determines the degree of the burn, conducts diagnostic procedures and select the appropriate treatment.

ICD-10 code

T26.5- a chemical burn and the area around the eyelid;
T26.6- a chemical burn with reagents with damage to the cornea and conjunctival sac;
T26.7- severe chemical burn with tissue damage, leading to rupture of the eyeball;
T26.8- a chemical burn that affected other parts of the eye;
T26.9- a chemical burn that affected the deep parts of the eyeball.

First aid

If the tissues of the eyeball, tissues of the eyelids and conjunctiva are damaged, the patient needs first aid.

So, the principles of its provision:

Do not wash your eyes with running water, use cosmetic creams. This can lead to increased signs of chemical exposure.

Once on the skin, the cream creates a protective shell from above, as a result of which the action of aggressive reagents is enhanced. For this reason, do not apply to skin creams or other cosmetic products.

What drugs can be used:

Potassium permanganate solution should be weak, it will help neutralize the action of aggressive substances. You can dilute potassium permanganate, prepare furatsilin, or simply rinse your eyes with warm, slightly salted water.

Rinse your eyes as often as possible, every 20-30 minutes. If the symptoms are pronounced, then you can take painkillers: Ibuprofen, Analgin or any other painkillers.

Treatment

It is advisable to consult a doctor at the first signs of a chemical burn. The doctor will select adequate therapy and help reduce unaccepted symptoms.

Most often, the following drugs are prescribed for treatment:

Antiseptics are part of combination therapy, they stop the inflammatory process and contribute to the restoration of soft tissues, relieve swelling and redness.

Antibacterial drugs are prescribed to stop the inflammatory process. They contribute to the death of pathogenic microflora and accelerate the process of cell regeneration.

Glucocorticosteroids can also be attributed to anti-inflammatory drugs, they enhance the effect of antibacterial drugs and antiseptics. With regular use, the intensity of unpleasant symptoms is reduced.

Local anesthetics are used in the form of drops. They help reduce the severity pain syndrome.

If there is an increase in the level of intraocular pressure (most often diagnosed by contact with alkalis), then medications are used that reduce the signs of intraocular hypertension.

Medicines based on human tears. They help to soften the irritated conjunctiva and reduce the signs of the inflammatory process, remove swelling and partially hyperthermia of the eyelid covers.

List of drugs prescribed for eye burns:

Group of drugs:	Name:
Glucocorticosteroids:	Prednisolone, Hydrocortisone in the form of an ointment.
Antibiotics:	Tetracycline, Erythromycin ointment
Antiseptics:	Sodium chloride, Potassium permanganate.
Anesthetics:	Dicaine solution.
Preparations based on human tears:	Visoptic, Vizin.
Drugs that reduce the manifestations of intraocular hypertension:	Acetazolamide, Timolol.
Medications that accelerate regenerative processes in cells:	Solcoseryl, Taurine.

Solcoseryl is available in the form of an ointment, the drug significantly speeds up the healing process and helps to avoid pronounced scarring of the tissue. And taurine, as a substance, “slows down” the development of irreversible changes in the sections of the eyeball. , like other medicines, describes in detail the dosage and frequency of use. Carefully follow the rules for the use of any drugs!

Timolol is precisely this substance that ophthalmologists prefer when signs of high intraocular pressure appear.

What to do if there was a chemical burn of the eye after eyelash extensions?

Getting burned during eyelash extensions occurs for several reasons. This can be exposure to heat - damage of a thermal nature or chemistry (getting on the skin of the eyelids or the mucous membrane of glue).

If you have problems with eyelash extensions, you should carry out the following procedures:

rinse eyes with a solution of potassium permanganate. Here is a link to help you understand.
drip Taurine or any other drops into the eyeballs to reduce the inflammatory process (drugs based on human tears can be used);
contact a doctor for help.

If the damage is localized, then an appeal to an ophthalmologist is necessary. Since only a doctor will be able to assess the seriousness of the situation and provide the patient with adequate assistance.

On the video - an eye burn after eyelash extensions:

If glue gets on the skin, then there is a possibility of developing blepharitis and other inflammatory diseases. To prevent this from happening, it is necessary to take appropriate measures and contact an ophthalmologist as soon as possible. But how to use it correctly and what is their price can be seen in this article.

You will also need to remove the extended eyelashes, since the glue irritates the skin of the eyelids and leads to an increase in unpleasant symptoms.

A chemical burn of the organs of vision is a severe injury that requires immediate treatment. You can give yourself first aid on your own, but it is advisable to take subsequent treatment under the supervision of a doctor.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Thermal and chemical burns limited to the eye and adnexa (T26)

Ophthalmology

general information

Short description

Recommended
Expert Council
RSE on PVC "Republican Center for Health Development"
Ministry of Health
and social development
dated October 15, 2015
Protocol #12

Burns limited to the area of the eye and its adnexa- this is a lesion of the eyeball and tissues around the eye due to chemical, thermal and radiation damaging agents.

Protocol name: Thermal and chemical burns limited to the area of the eye and its adnexa.

ICD-10 code(s):

T26.0 Thermal burn of eyelid and periorbital region
T26.1 Thermal burn of cornea and conjunctival sac
T26.2 Thermal burn resulting in laceration and destruction of eyeball
T26.3 Thermal burn of other parts of eye and adnexa
T26.4 Thermal burn of eye and adnexa, unspecified
T26.5 Chemical burn of eyelid and periorbital region
T26.6 Chemical burn of cornea and conjunctival sac
T26.7 Chemical burn leading to laceration and destruction of eyeball
T26.8 Chemical burns of other parts of eye and adnexa
T26.9 Chemical burn of eye and adnexa, unspecified

Abbreviations used in the protocol:
ALT - alanine aminotransferase

AST - aspartate aminotransferase
In / in - intravenously
V\m - intramuscularly
GKS - glucocorticosteroids
INR - international normalized ratio
P\b - parabulbarno
P \ to - subcutaneously
PTI - prothrombin index
UD - level of evidence
ECG - electrocardiographic study

Date of development/revision of the protocol: 2015

Protocol Users: therapists, pediatricians, doctors general practice, ophthalmologists.

Evaluation of the evidence level of the given recommendations.
Evidence level scale:

Level evidence	Type of Evidence
	Evidence obtained from meta-analysis a large number well-designed randomized trials. Randomized trials with low level false positive and false negative errors.
	The evidence is based on the results of at least one well-designed, randomized trial. Randomized trials with high level false positive and false negative errors
III	The evidence is based on well-designed, non-randomized studies. Controlled studies with one group of patients, studies with a historical control group, etc.
	The evidence comes from non-randomized trials. Indirect comparative, descriptively correlated and case studies
V	The evidence is based on clinical cases and examples

Classification

Clinical classification
Depending on the influencing factor:
· chemical;
· thermal;
radiation;
combined.

According to the anatomical localization of damage:
Auxiliary organs (eyelids, conjunctiva);
eyeball (cornea, conjunctiva, sclera, deeper structures);
several related structures.

By severity of damage:
I degree - easy;
II degree - medium degree;
III (a and b) degree - severe;
IV degree - very severe.

Diagnostics

The list of basic and additional diagnostic measures:
Diagnostic measures taken at the stage of emergency care:
Collection of anamnesis and complaints.
The main (mandatory) diagnostic examinations carried out at the outpatient level:
Visometry (UD - C);
Ophthalmoscopy (UD - C);

biomicroscopy of the eye (UD - C).
Additional diagnostic examinations performed at the outpatient level:
perimetry (UD - C);
Tonometry (UD - C);
echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C);

The main (mandatory) diagnostic examinations carried out at the hospital level during emergency hospitalization and after more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
collection of complaints, anamnesis of the disease and life;
· general blood analysis;
· general urine analysis;
· biochemical analysis blood (total protein, its fractions, urea, creatinine, bilirubin, ALT, AST, electrolytes, blood glucose);
· coagulogram (PTI, fibrinogen, FA, clotting time, INR);
microreaction;
a blood test for HIV method ELISA;
determination of HBsAg in blood serum by ELISA;
determination of total antibodies to hepatitis C virus in blood serum by ELISA;
determination of the blood group according to the ABO system;
Determination of the Rh factor of the blood;
Visometry (UD - C);
Ophthalmoscopy (UD - C);
Determination of corneal surface defects (UD - C);
biomicroscopy of the eye (UD - C);
EKG.
Additional diagnostic examinations carried out at the hospital level during emergency hospitalization and after more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
perimetry (UD - C);
Tonometry (UD - C);
echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C) *;
X-ray of the orbit (if there are signs combined damage eyelids, conjunctiva and eyeball, to exclude foreign bodies) (UD - C).

Diagnostic criteria for making a diagnosis:
Complaints and anamnesis
Complaints:
pain in the eye
lacrimation;
severe photophobia;
· blepharospasm;
Decreased visual acuity.
Anamnesis:
clarification of the circumstances of the eye injury (type of burn, type chemical).

Instrumental research:
visometry - decreased visual acuity;
biomicroscopy - violation of the integrity of the structures of the eyeball, depending on the severity of the damage;
Ophthalmoscopy - weakening of the reflex from the fundus;
Determination of defects in the surface of the cornea - the area of damage to the cornea, depending on the severity of the burn;

Indications for consultation of narrow specialists:
consultation of a therapist - for evaluation general condition organism.

Differential Diagnosis

Differential Diagnosis.
Table - 1. Differential diagnosis of eye burns according to severity

Burn degree	Leather	Cornea	Conjunctiva and sclera
I	hyperemia of the skin, superficial exfoliation of the epidermis.	islet staining with fluorescein, dull surface	hyperemia, islet staining
II	blistering, peeling of the entire epidermis.	film that is easily removed, deepithelialization, continuous staining.	pallor, gray films that are easily removed.
III a	necrosis of the superficial layers of the skin itself (up to the germ layer)	superficial clouding of the stroma and Bowman's membrane, folds of the Descemet's membrane (if its transparency is preserved).	pallor and chemosis.
3rd century	necrosis of the entire thickness of the skin	deep clouding of the stroma, but without early changes in the iris, a sharp violation of sensitivity in the limbus.	exposure and partial rejection of the deathly pale sclera.
IV	deep necrosis of not only the skin, but also the subcutaneous tissue, muscles, cartilage.	simultaneously with changes in the cornea up to detachment of the Descemet's membrane ("porcelain plate"), depigmentation of the iris and immobility of the pupil, clouding of the moisture of the anterior chamber and lens.	melting of the exposed sclera to the vascular tract, clouding of the moisture of the anterior chamber and the lens, the vitreous body.

Table - 2. Differential diagnosis of chemical and thermal eye burns

Nature of damage	alkali burn	acid burn
type of damage	colliquational necrosis	coagulative necrosis
intensity of primary corneal opacity	weakly expressed	strongly expressed
damage depth	clouding of the cornea does not correspond to the depth of tissue damage	clouding of the cornea corresponds to the depth of tissue damage
damage to the structures of the eye	rapid	slow
development of iridocyclitis	rapid	slow
neutralizers	2% boric acid solution	3% solution of bicarbonate soda

Treatment

Treatment goals:
Reduction of the inflammatory reaction of the tissues of the eye;
relief of pain syndrome;
restoration of the surface (epithelization) of the eye.

Treatment tactics:
For burns of the 1st degree - treatment is carried out on an outpatient basis, under the supervision of an ophthalmologist;
In case of burns of II-IV degrees - emergency hospitalization in a hospital is indicated.

Medical treatment:
Drug treatment provided at the stage of emergency emergency care:

Medical treatment provided on an outpatient basis (for burnsI degree) :
· in the presence of a powdered chemical or its pieces on the eyelids and conjunctiva, remove it with damp cotton or gauze;
local anesthetics (oxybuprocaine 0.4% or proximethacaine 0.5%) 1-2 drops in the conjunctival cavity once (UD - C);
Abundant, prolonged (at least 20 minutes), washing of the conjunctival cavity with cool (12 0 -18 0 C) running water or water for injection (during washing, the patient's eyes must be open);

mydriatics (the choice of drugs is at the discretion of the doctor) - cyclopentolate 1%, tropicamide 1%, ophthalmic phenylephrine 2.5% and 10% epibulbarno 1-2 drops up to 3 times a day for 3-5 days in order to prevent the development of inflammatory process in the anterior vascular tract (UD - C);

Medical treatment provided at the hospital level:
burnsIIdegrees:
local anesthetics (oxybuprocaine 0.4% or proximethacaine 0.5%) instillations before washing the conjunctival cavity, immediately before surgery, pain relief if necessary (LE - C);
In case of a chemical burn, abundant, prolonged (at least 20 minutes), continuous irrigation of the conjunctival cavity with an alkali neutralizer (2% boric acid solution or 5% citric acid solution or 0.1% lactic acid solution or 0.01% acetic acid solution), for acids ( 2% sodium bicarbonate solution). Chemical neutralizers are used during the first hours after a burn; in the future, the use of these drugs is inappropriate and can have a damaging effect on the burned tissue (LE - C);
In case of a thermal burn, rinse with cool (120-180C) running water / water for injection (during the rinse, the patient's eyes should be open).
washing is not carried out with a thermochemical burn when a penetrating wound is detected;
local antibacterial agents(chloramphenicol eye 0.25% or ciprofloxacin eye 0.3% or ofloxacin eye 0.3%) - children over 1 year old and adults immediately after washing the conjunctival cavity, as well as 1 drop 4 times a day epibulbarno for 5-7 days (for prevention infectious complications) (UD - C);
Antibacterial agents for topical external use (ofloxacin ophthalmic 0.3% or tobramycin 0.3%) - for children over 1 year old and adults 2-3 times a day on the burn surface (according to indications) (UD - C);
non-steroidal anti-inflammatory drugs (diclofenac ophthalmic 0.1%) - 1 drop 4 times a day epibulbarno (in the absence of epithelial defects) for 8-10 days. (UD - C);
mydriatics - ophthalmic atropine 1% (adults), 0.5%, 0.25%, 0.125% (children) 1 drop 1 time per day epibulbarno, cyclopentolate 1%, tropicamide 1%, phenylephrine ophthalmic 2.5% and 10% epibulbarno 1-2 drops up to 3 times a day for the prevention and treatment of the inflammatory process in the anterior vascular tract (UD - C);
Regeneration stimulants, keratoprotectors (dexpanthenol 5 mg) - 1 drop 3 times a day epibulbarno. In order to improve the trophism of the anterior surface of the eyeball, accelerate the healing of erosions (UD - C);
With an increase in intraocular pressure: non-selective "B" blockers (timolol 0.25% and 0.5%) -. Contraindicated in: bronchial obstruction, bradycardia less than 50 beats per minute, systemic hypotension; Carbonic anhydrase inhibitors (dorzolamide 2%, or brinzolamide 1%) - epibulbarno 1 drop 2 times a day (UD - C);
for pain - analgesics (ketorolac 1 ml IM) as needed (UD - C);

burnsIII- IVdegrees(in addition to the above, additionally assigned):
Anti-tetanus serum 1500-3000 IU s / c to reduce intoxication when the burn wound is contaminated;
Non-steroidal anti-inflammatory drugs - diclofenac inside 50 mg 2-3 times a day before meals, course 7-10 days (UD - C);
GCS (dexamethasone 0.4%) p / b 0.5 ml daily / every other day (not earlier than 5-7 days - according to indications, not in acute phase triamcinolone 4% 0.5 ml p / b 1 time). With anti-inflammatory, decongestant, anti-allergic, anti-exudative purpose (UD - C);
Antibacterial drugs (according to indications for severe burns in the 1st and 2nd stage of burn disease) enterally / parenterally - azithromycin 250 mg, 500 mg - 1 TB 2 times a day for 5-7 days, 0.5 or 0.25 ml in / in 1 once a day for 3 days; cefuroxime 750 mg twice daily for 5–7 days, ceftriaxone 1.0 IV once daily for 5–7 days (LE-C).

Non-drug treatment:
General mode II-III, table No. 15.

Surgical intervention:
Surgical interventions for eye burnsIII- IV stages:
conjunctivotomy;
necrectomy of the conjunctiva and cornea;
blepharoplasty, blepharorrhaphy;
· Layered and penetrating keratoplasty, biocovering of the cornea.

Surgical intervention provided in a hospital:

Conjunctivotomy(ICD-9: 10.00, 10.10, 10.33, 10.99) :
Indications:
Pronounced swelling of the conjunctiva;
Risk of limbal ischemia.
Contraindications:
general somatic status.

Necrectomy of the conjunctiva and cornea(ICD-9: 10.31, 10.41, 10.42, 10.43, 10.44, 10.49, 10.50, 10.60, 10.99, 11.49) .
Indications:
· the presence of foci of necrosis.
Contraindications:
general somatic status.

Blepharoplasty(early primary), blepharorrhaphy(ICD-9: 08.52, 08.59, 08.61, 08.62, 08.64, 08.69, 08.70, 08.71, 08.72, 08.73, 08.74, 08.89, 08.99):
Indications:
Severe burn injuries of the eyelids, with the impossibility of complete closure of the palpebral fissure;
Contraindications:
general somatic status.

Keratoplasty layered / through, bio-covering the cornea(ICD-9: 11.53, 11.59, 11.61, 11.62, 11.63, 11.64, 11.69, 11.99).
Indications:
Threat of perforation / perforation of the cornea, with a therapeutic and organ-preserving purpose.
Contraindications:
general somatic status.

Further management:
· for burns of mild severity, outpatient treatment under the supervision of an ophthalmologist of an outpatient-polyclinic level;
After the end of inpatient treatment, the patient enters the dispensary registration with an ophthalmologist at the place of residence (up to 1 year) with the necessary recommendations (volume and frequency of dispensary examinations).
Reconstructive surgery (not earlier than a year after the injury) - eyelid surgery, conjunctival cavity surgery, keratoprosthetics, keratoplasty.

Treatment effectiveness indicators:
relief of the inflammatory process;
Complete epithelialization of the cornea;
restoration of the transparency of the cornea;
Improvement of visual functions;
absence of cicatricial changes of the eyelid and conjunctiva;
absence of secondary complications;
Formation of a vascularized corneal leukoma.

Drugs (active substances) used in the treatment

Azithromycin (Azithromycin)
Atropine (Atropine)
Boric acid
Brinzolamide (Brinzolamide)
Dexamethasone (Dexamethasone)
Dexpanthenol (Dexpanthenol)
Diclofenac (Diclofenac)
Dorzolamide (Dorzolamide)
Ketorolac (Ketorolac)
Citric acid
Lactic acid
Sodium bicarbonate (Sodium hydrocarbonate)
Oxybuprocaine (Oxybuprocaine)
Ofloxacin (Ofloxacin)
Proxymetacaine (Proxymetacaine)
Anti-tetanus serum (Serum tetanus)
Timolol (Timolol)
Tobramycin (Tobramycin)
Tropikamid (Tropikamid)
Acetic acid
Phenylephrine (Phenylephrine)
Chloramphenicol (Chloramphenicol)
Ceftriaxone (Ceftriaxone)
Cefuroxime (Cefuroxime)
Cyclopentolate (Cyclopentolate)
Ciprofloxacin (Ciprofloxacin)

Hospitalization

Indications for hospitalization, indicating the type of hospitalization:

Indications for emergency hospitalization:
burns of the eyes and its appendages of moderate or more severity.
Indications for planned hospitalization: No

Information

Sources and literature

Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
1. List of used literature (valid research references to the listed sources are required in the text of the protocol): 1) Eye diseases: textbook / Under. ed. V.G. Kopaeva. - M.: Medicine, 2002. - 560 p. 2) Jaliashvili O.A., Gorban A.I. First aid for acute diseases and eye damage. - 2nd ed., revised. and additional - St. Petersburg: Hippocrates, 1999. - 368 p. 3) Puchkovskaya N.A., Yakimenko S.A., Nepomnyashchaya V.M. Eye burns. - M.: Medicine, 2001. - 272 p. 4) Ophthalmology: national leadership / Ed. C.E. Avetisova, E.A. Egorova, L.K. Moshetova, V.V. Neroeva, H.P. Takhchidi. - M.: GEOTAR-Media, 2008. - 944 p. 5) Egorov E.A., Alekseev V.N., Astakhov Yu.S., Brzhesky V.V., Brovkina A.F., et al. Rational pharmacotherapy in ophthalmologists: a guide for practitioners / Ed. ed. E.A. Egorova. – M.: Litterra, 2004. – 954 p. 6) Atkov O.Yu., Leonova E.S. Plans for the management of patients "Ophthalmology" evidence-based medicine, GEOTAR - Media, Moscow, 2011, p.83-99. 7) Guideline: Work Loss Data Institute. eye. Encinitas (CA): Work Loss Data Institute; 2010. Various p. 8) Egorova E.V. et al. Technology of surgical interventions for extensive post-traumatic defects and deformities in the eyelid area \\ Mater. 111 Euro-Asian Conf. in ophthalmic surgery. - 2003, Yekaterinburg. - With. 33

Information

List of protocol developers with qualification data:

1) Isergepova Botagoz Iskakovna - candidate medical sciences, Head of the Department of Management of Scientific and Innovative Research of JSC "Kazakh Research Institute of Eye Diseases".
2) Makhambetov Dastan Zhakenovich - ophthalmologist of the 1st category, JSC "Kazakh Research Institute of Eye Diseases".
3) Mukhamedzhanova Gulnara Kenesovna - Candidate of Medical Sciences, Assistant of the Department of Ophthalmology of the RSE on REM "Kazakh National Medical University Asfendiyarova S.D.
4) Zhusupova Gulnara Darigerovna - Candidate of Medical Sciences, Associate Professor of the Department of JSC "Astana Medical University".

Indication of no conflict of interest: No

Reviewer: Shusterov Yury Arkadyevich - Doctor of Medical Sciences, Professor, RSE on REM "Karaganda State Medical University", Head of the Department of Ophthalmology.

Indication of the conditions for revising the protocol:
Revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.

Attached files

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Rendering Protocol medical care with thermal burns of the cornea and conjunctival sac

ICD code - 10
T 26.1
T 26.2
T 26.3
T 26.4

Signs and diagnostic criteria:

A thermal burn occurs due to the effect of a thermal factor on tissues: flame, steam, hot liquids, hot gases, light irradiation, molten metal.

The clinic of burn severity depends on the degree of necrosis (area and depth).


Burn degree	Cornea	Conjunctiva
	Islet staining with fluorescein, dull surface;	Hyperemia, islet staining
second	Easily removable film, de-epithelialization, continuous staining	Pale, gray films that are easy to remove
third A	Superficial turbidity of the stroma and Bowman's membrane, folds of the Descemet's membrane (even while maintaining its transparency)	Paleness and chemosis
third B	Deep clouding of the stroma, but without early changes in the iris, a sharp violation of sensitivity in the limbus	Exposure and partial rejection of the pallid sclera
fourth	Simultaneously with changes in the cornea up to detachment of the Descemet's membrane, depigmentation of the iris and immobility of the pupil, clouding of the moisture of the anterior chamber and lens	Melting of the exposed sclera to the vascular tract, clouding of the moisture of the anterior chamber and lens, vitreous body

According to the severity of burns are divided:
The easiest- I degree of any localization and plane
Light- II degree of any localization and plane
Medium- degree III - A for the cornea - outside the optical zone, for the conjunctiva and sclera - limited (up to 50% of the arch)
Heavy- degree III - B and IV degree - for the cornea - limited, but with damage to the optical zone; for the conjunctiva - common, more than 50% of the arch.

With burns, starting from the II degree - mandatory prophylaxis of tetanus.

Levels of medical care:
Second level - polyclinic ophthalmologist (1st degree burns)
The third level - an ophthalmological hospital (starting with second-degree burns), a trauma center

Surveys:
1. External examination
2. Visometry
3. Perimetry
4. Biomicroscopy

Mandatory laboratory tests:
(Urgent hospitalization, later)
1. General analysis blood
2. Urinalysis
3. Blood on RW
4. Blood sugar
5. Hbs antigen

Consultations of specialists according to indications:
1. Therapist
2. Surgeon - combustiologist

Characteristics of therapeutic measures:

Burn of the cornea and conjunctiva of the 1st degree - outpatient treatment

Burn of the cornea and conjunctiva II degree - conservative treatment in the hospital;

III A degree corneal burn - necrectomy and layered keratoplasty or superficial therapeutic transplantation of the cornea, conjunctiva - conjunctivotomy according to Pasov, Denig operation (transplantation of the oral mucosa) in the Puchkovskaya or Shatilova modification

Corneal burn III B degree - penetrating keratoplasty, conjunctival burn - Denig operation (transplantation of the oral mucosa) in the modification of Puchkovskaya or according to Shatilova

Burns of the cornea and conjunctiva of the IV degree - transplantation of a piece of the oral mucosa onto the entire anterior surface of the eye and blepharorrhaphy.

Conservative treatment:
1. midriatiki
2. antibacterial drops(sulfacyl sodium, chloramphenicol, gentamicin, tobramycin, okacin, ciprolet, normax, ciprofloxacin and others) parabulbar antibiotics (gentamicin, tobramycin, carebenicillin, penicillin, netromycin, lincomycin, kanamycin, etc.) ointments (levomycetin, erythromycin, tetracycline, sodium sulfacyl )
3. anti-inflammatory (naklof, diclo-F, corticosteroids - in drops and parabulbarno)
4. protilytic enzyme inhibitors (gordox, contrykal)
5. antihypertensive therapy when indicated (timolol, betoptik and others)
6. antitoxic therapy (hemodez, reopoliglyukin IV)
7. antioxidant drops (emoxipin, 5% alpha-tocopherol)
8. means that regulate metabolism and trophism (taufon, sea buckthorn oil, gels of actovegin and solcoseryl, retinol acetate, quinax, oftan-catahrom, keracol and others), under the conjunctiva - ascorbic acid, ATP, riboflavin mononucleotides
9. systemic therapy - antibiotics orally, intramuscularly, intravenously; anti-inflammatory (orally - indomethacin, diclofenac, i / m - volt arene, diclofenac); hypotensive (diacarb, glyceryl); therapy against autosensitization and autointoxication (in / in calcium chloride, in / m - diphenhydramine, suprastin, orally - diphenhydramine, tavegil, suprastin); means regulating metabolism (in / m actovegin, vitamins B1, B2, ascorbic acid); vasodilator therapy (orally - cavinton, no-shpa, a nicotinic acid, i / v - cavinton, reopoliglyukin, i / m - nicotinic acid)

III-IV degree burns are subject to treatment in the trauma and burn center of the Institute of Eye Diseases and Tissue Therapy. acad. V. P. Filatova of the Academy of Medical Sciences of Ukraine

End Expected Result- organ-preserving effect, preservation of vision

Duration of treatment
First degree burns - 3 - 5 days
Second degree burns - 7-10 days
Third degree burns (A and B) - 2-4 weeks
Fourth degree burns - 2 months

Treatment quality criteria:
First and second degree burns - recovery
Third-degree burns (A and B) - organ-preserving effect, no symptoms of inflammation, decreased function, which does not significantly affect performance or disability, and it is possible to preserve the prospects for partial restoration of functions
Fourth degree burns - loss of an eye, disability

Possible side effects and complications:
Eye infection, eye loss

Dietary Requirements and Restrictions:
Not

Requirements for the regime of work, rest and rehabilitation:
Patients are disabled: the first degree - 1 week, the second degree - 3-4 weeks; third degree - 4-6 weeks; fourth degree - partial permanent disability, disability. 4th degree burns require further re-hospital treatment within a year
Disability is determined by the degree of burn, the volume of surgical intervention, the need for late reconstructive operations.

15-10-2012, 06:52

Description

SYNONYMS

Chemical, thermal, radiation damage to the eyes.

ICD-10 CODE

T26.0. Thermal burn of the eyelid and periorbital region.

T26.1. Thermal burn of the cornea and conjunctival sac.

T26.2. Thermal burn leading to rupture and destruction of the eyeball.

T26.3. Thermal burns of other parts of the eye and its adnexa.

T26.4. Thermal burn of the eye and adnexa of unspecified localization.

T26.5. Chemical burn of the eyelid and periorbital region.

T26.6. Chemical burn of the cornea and conjunctival sac.

T26.7. Chemical burn leading to rupture and destruction of the eyeball.

T26.8. Chemical burn of other parts of the eye and its adnexa.

T26.9. Chemical burn of the eye and adnexa of unspecified localization.

T90.4. Sequelae of an eye injury in the periorbital region.

CLASSIFICATION

I degree- hyperemia of various parts of the conjunctiva and the limbus zone, superficial erosion of the cornea, as well as hyperemia of the skin of the eyelids and their swelling, slight swelling.
II degree b - ischemia and superficial necrosis of the conjunctiva with the formation of easily removable whitish scabs, clouding of the cornea due to damage to the epithelium and superficial layers of the stroma, the formation of blisters on the skin of the eyelids.
III degree- necrosis of the conjunctiva and cornea to deep layers, but not more than half of the surface area of the eyeball. The color of the cornea is "matte" or "porcelain". Changes in ophthalmotonus are noted in the form of a short-term increase in IOP or hypotension. Perhaps the development of toxic cataracts and iridocyclitis.
IV degree- deep lesion, necrosis of all layers of the eyelids (up to charring). Damage and necrosis of the conjunctiva and sclera with vascular ischemia on the surface of more than half of the eyeball. The cornea is "porcelain", a tissue defect over 1/3 of the surface area is possible, in some cases perforation is possible. Secondary glaucoma and severe vascular disorders - anterior and posterior uveitis.

ETIOLOGY

Conventionally, chemical (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and radiation burns are distinguished.

CLINICAL PICTURE

Common signs of eye burns:

the progressive nature of the burn process after the cessation of exposure to the damaging agent (due to metabolic disorders in the tissues of the eye, the formation of toxic products and the occurrence of an immunological conflict due to autointoxication and autosensitization by the post-burn period);
a tendency to recurrence of the inflammatory process in the choroid at different times after receiving a burn;
a tendency to the formation of synechia, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.

Stages of the burn process:

Stage I (up to 2 days) - the rapid development of necrobiosis of the affected tissues, excessive hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acid polysaccharides;
Stage II (2-18 days) - manifestation of pronounced trophic disorders due to fibrinoid swelling:
Stage III (up to 2-3 months) - trophic disorders and vascularization of the cornea due to tissue hypoxia;
Stage IV (from several months to several years) - a period of scarring, an increase in the amount of collagen proteins due to an increase in their synthesis by corneal cells.

DIAGNOSTICS

Diagnosis is based on history and clinical presentation.

TREATMENT

Basic principles of treatment of eye burns:

providing emergency care aimed at reducing the damaging effect of a burn agent on tissues;
subsequent conservative and (if necessary) surgical treatment.

Washing is not carried out with a thermochemical burn if a penetrating wound is found!

Surgical interventions on the eyelids and the eyeball in the early stages are carried out only in order to preserve the organ. Vitrectomy of burned tissues, early primary (in the first hours and days) or delayed (after 2-3 weeks) blepharoplasty with a free skin flap or a skin flap on a vascular pedicle with a simultaneous transplantation of automucosa on the inner surface of the eyelids, arches and sclera are performed.

Planned surgical interventions on the eyelids and the eyeball with the consequences of thermal burns are recommended to be carried out 12-24 months after the burn injury, since against the background of autosensitization of the body, allosensitization to the graft tissues occurs.

For severe burns, 1500-3000 IU of tetanus toxoid should be injected subcutaneously.

Treatment of stage I eye burns

Prolonged irrigation of the conjunctival cavity (within 15-30 minutes).

alkali - 2% boric acid solution, or 5% citric acid solution, or 0.1% lactic acid solution, or 0.01% acetic acid:
acid - 2% sodium bicarbonate solution.

With severe symptoms of intoxication, belvidone is prescribed intravenously once a day, 200-400 ml at night, drip (up to 8 days after injury), or 5% dextrose solution with ascorbic acid 2.0 g in a volume of 200-400 ml, or 4- 10% dextran solution [cf. they say weight 30,000-40,000], 400 ml intravenous drip.

Antioxidants: methylethylpyridinol (1% solution of 1 ml intramuscularly or 0.5 ml parabulbarno 1 time per day, for a course of 10-15 injections).

Analgesics: metamizole sodium (50%, 1-2 ml intramuscularly for pain) or ketorolac (1 ml for pain intramuscularly).

Preparations for instillation into the conjunctival cavity

In severe conditions and in the early postoperative period, the frequency of instillations can reach 6 times a day. As the inflammatory process decreases, the duration between instillations increases.

Antibacterial agents: ciprofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or ofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or tobramycin 0.3% ( eye drops, 1-2 drops 3-6 times a day).

Antiseptics: picloxidine 0.05% 1 drop 2-6 times a day.

Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone (eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisone (eye drops 0.5% 1-2 drops 3-6 times a day).

NSAIDs: diclofenac (orally 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (orally 25 mg 2-3 times a day after meals, course 10-14 days).

Surgery: sectoral conjunctivotomy, corneal paracentesis, conjunctival and cornea necrectomy, genonoplasty, corneal biocoverage, eyelid surgery, layered keratoplasty.

Treatment of stage II eye burns

Groups of drugs are added to the ongoing treatment, stimulating immune processes, improving the utilization of oxygen by the body and reducing tissue hypoxia.

fibrinolysis inhibitors: aprotinin 10 ml intravenously, for a course of 25 injections; instillation of the solution into the eye 3-4 times a day.

Antioxidants: methylethylpyridinol (1% solution of 0.5 ml parabulbarno 1 time per day, for a course of 10-15 injections) or vitamin E (5% oil solution, inside 100 mg, 20-40 days).

Surgery: layered or penetrating keratoplasty.

Treatment of stage III eye burns

The following are added to the treatment described above.

Short-acting mydriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day).

Antihypertensive drugs: betaxolol (0.5% eye drops, twice daily) or timolol (0.5% eye drops, twice daily) or dorzolamide (2% eye drops, twice daily).

Surgery: keratoplasty according to emergency indications, antiglaucoma operations.

Treatment of stage IV eye burns

The following are added to the ongoing treatment.

Enzyme preparations in the form of injections:

fibrinolysin [human] (400 IU parabulbarno):
collagenase 100 or 500 KE (the contents of the vial are dissolved in 0.5% procaine solution, 0.9% sodium chloride solution or water for injection). It is administered subconjunctivally (directly into the lesion: adhesion, scar, ST, etc. using electrophoresis, phonophoresis, and also applied to the skin. Before use, the patient's sensitivity is checked, for which 1 KE is injected under the conjunctiva of the diseased eye and observed for 48 hours. In the absence of an allergic reaction, treatment is carried out for 10 days.

Non-drug treatment

Physiotherapy, eyelid massage.

Approximate periods of incapacity for work

Depending on the severity of the lesion, they are 14-28 days. Possible disability in the event of complications, loss of vision.

Further management

Observation of an ophthalmologist at the place of residence for several months (up to 1 year). Control of ophthalmotonus, state of ST, retina. With a persistent increase in IOP and the absence of compensation on a medical regimen, antiglaucomatous surgery is possible. With the development of traumatic cataract, removal of the cloudy lens is indicated.

FORECAST

Depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the victim's admission to the hospital, the correctness of the appointment of drug therapy.

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