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British Journal of Hospital Medicine... Mar 2022Chemical burns represent a small number of burn injuries in the UK. They have the potential to be life-threatening with serious aesthetic and functional consequences,... (Review)
Review
Chemical burns represent a small number of burn injuries in the UK. They have the potential to be life-threatening with serious aesthetic and functional consequences, accounting for 30% of all deaths from burns. Chemical burns are caused by corrosive agents (acids and alkali) leading to extensive tissue damage. Understanding the pathophysiology of a chemical burn injury and identifying the nature of the offending agent is important for effective management. Prompt assessment and management of chemical injuries is vital to reduce the deleterious effect of the compound involved. This article reviews the pathophysiology of a chemical injury and the management of these burns.
Topics: Burns, Chemical; Humans
PubMed: 35377199
DOI: 10.12968/hmed.2020.0056 -
Eye (London, England) Sep 2019Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular... (Review)
Review
Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as key challenges. Education and prevention are therefore important public health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherence rates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.
Topics: Acids; Alkalies; Animals; Burns, Chemical; Eye Burns; Humans
PubMed: 31086244
DOI: 10.1038/s41433-019-0456-5 -
American Family Physician Jan 2010Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common... (Review)
Review
Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare. Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. Allergies or irritants also may cause conjunctivitis. The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.
Topics: Algorithms; Anti-Bacterial Agents; Blepharitis; Burns, Chemical; Corneal Diseases; Corneal Ulcer; Diagnosis, Differential; Dry Eye Syndromes; Endophthalmitis; Eye Burns; Eye Diseases; Eye Foreign Bodies; Eye Infections; Eye Injuries; Family Practice; Glaucoma; Glucocorticoids; Humans; Keratoconjunctivitis; Primary Health Care
PubMed: 20082509
DOI: No ID Found -
Translational Vision Science &... Jul 2022To evaluate the efficacy of losartan and prednisolone acetate in inhibiting corneal scarring fibrosis after alkali burn injury in rabbits.
PURPOSE
To evaluate the efficacy of losartan and prednisolone acetate in inhibiting corneal scarring fibrosis after alkali burn injury in rabbits.
METHODS
Sixteen New Zealand White rabbits were included. Alkali injuries were produced using 1N sodium hydroxide on a 5-mm diameter Whatman #1 filter paper for 1 minute. Four corneas in each group were treated six times per day for 1 month with 50 µL of (1) 0.8 mg/mL losartan in balanced salt solution (BSS), (2) 1% prednisolone acetate, (3) combined 0.8 mg/mL losartan and 1% prednisolone acetate, or (4) BSS. Area of opacity and total opacity were analyzed in standardized slit-lamp photos with ImageJ. Corneas in both groups were cryofixed in Optimal cutting temperature (OCT) compound at 1 month after surgery, and immunohistochemistry was performed for alpha-smooth muscle actin (α-SMA) and keratocan or transforming growth factor β1 and collagen type IV with ImageJ quantitation.
RESULTS
Combined topical losartan and prednisolone acetate significantly decreased slit-lamp opacity area and intensity, as well as decreased stromal myofibroblast α-SMA area and intensity of staining per section and confined myofibroblasts to only the posterior stroma with repopulation of the anterior and mid-stroma with keratocan-positive keratocytes after 1 month of treatment. Corneal fibroblasts produced collagen type IV not associated with basement membranes, and this production was decreased by topical losartan.
CONCLUSIONS
Combined topical losartan and prednisolone acetate decreased myofibroblast-associated fibrosis after corneal alkali burns that produced full-thickness injury, including corneal endothelial damage. Increased dosages and duration of treatment may further decrease scarring fibrosis.
TRANSLATIONAL RELEVANCE
Topical losartan and prednisolone acetate decrease myofibroblast-mediated scarring fibrosis after corneal injury.
Topics: Adrenal Cortex Hormones; Alkalies; Animals; Burns, Chemical; Cicatrix; Collagen Type IV; Corneal Diseases; Corneal Injuries; Fibrosis; Losartan; Myofibroblasts; Rabbits
PubMed: 35819289
DOI: 10.1167/tvst.11.7.9 -
BMJ (Clinical Research Ed.) Jun 2004
Review
Topics: Burns; Burns, Chemical; Burns, Electric; Child; Child Abuse; Cytokines; Humans
PubMed: 15191982
DOI: 10.1136/bmj.328.7453.1427 -
Canadian Journal of Surgery. Journal... Jun 1996To report a burn unit's experience with chemical burns and to discuss the fundamental principles in managing chemical burns.
OBJECTIVES
To report a burn unit's experience with chemical burns and to discuss the fundamental principles in managing chemical burns.
DESIGN
A chart review.
SETTING
A burn centre at a major university-affiliated hospital.
PATIENTS
Twenty-four patients with chemical burns, representing 2.6% of all burn admissions over an 8-year period at the Ross Tilley Regional Adult Burn Centre. Seventy-five percent of the burn injuries were work-related accidents. Chemicals involved included hydrofluoric acid, sulfuric acid, black liquor, various lyes, potassium permanganate and phenol.
RESULTS
Fourteen patients required excision and skin grafting. Complications were frequent and included ocular chemical contacts, wound infections, tendon exposures, toe amputation and systemic reactions from absorption of chemical. One patient died from a chemical scald burn to 98% of the body surface area.
CONCLUSIONS
The key principles in the management of chemical burns include removal of the chemical, copious irrigation, limited use of antidotes, correct estimation of the extent of injury, identification of systemic toxicity, treatment of ocular contacts and management of chemical inhalation injury. Individualized treatment is emphasized.
Topics: Adult; Aged; Amputation, Surgical; Antidotes; Burn Units; Burns, Chemical; Emergency Medical Services; Female; Hospitalization; Humans; Male; Middle Aged; Retrospective Studies; Skin Transplantation; Therapeutic Irrigation; Wound Infection
PubMed: 8640619
DOI: No ID Found -
Clinics in Plastic Surgery Jul 2017This article reviews the unique challenges presented by chemical, electrical, and radiation injuries. The authors discuss pathophysiology and diagnosis of these injuries... (Review)
Review
This article reviews the unique challenges presented by chemical, electrical, and radiation injuries. The authors discuss pathophysiology and diagnosis of these injuries and provide recommendations for management.
Topics: Burns, Chemical; Burns, Electric; Humans; Radiation Injuries
PubMed: 28576255
DOI: 10.1016/j.cps.2017.02.021 -
American Family Physician Oct 2013Ocular emergencies such as retinal detachments, mechanical globe injuries, and chemical injuries can cause permanent vision loss if they are not recognized and treated... (Review)
Review
Ocular emergencies such as retinal detachments, mechanical globe injuries, and chemical injuries can cause permanent vision loss if they are not recognized and treated promptly. Family physicians should be familiar with the signs and symptoms associated with each condition, and be able to perform a basic eye examination to assess the situation. The assessment includes measurement of visual acuity, pupillary examination, visual field testing, slit lamp or penlight examination of the anterior segment of the eye, and direct funduscopic examination. Patients with symptomatic floaters and flashing lights require a dilated fundoscopic examination and prompt referral to an ophthalmologist for evaluation of a retinal tear or detachment. A globe laceration or rupture should be suspected in patients with a recent history of trauma from a blunt or penetrating object. Prophylactic oral antibiotics can be administered after a globe injury to prevent endophthalmitis, and the eye should be covered with a metal shield until evaluation by an ophthalmologist. Chemical injuries require immediate irrigation of the eye to neutralize the pH of the ocular surface.
Topics: Burns, Chemical; Emergencies; Eye Burns; Eye Injuries; Humans; Prognosis; Retinal Detachment
PubMed: 24364572
DOI: No ID Found -
Romanian Journal of Ophthalmology 2016Glaucoma after chemical burns represents a posttraumatic glaucoma, usually open-angle glaucoma. It is a frequent complication of chemical burns, especially with alkali... (Review)
Review
Glaucoma after chemical burns represents a posttraumatic glaucoma, usually open-angle glaucoma. It is a frequent complication of chemical burns, especially with alkali and it can appear in the acute stage or as a late complication. Because of the complications and scars, the treatment is very difficult. Topical treatment is based on AC inhibitors, β-blockers, α2-agonists. Trabeculectomy, shunts, cyclophotocoagulation, and cryotherapy are the solutions in the late stages. Glaucoma after irradiation is a closing-angle secondary glaucoma. The risk factors such as the radiation dose and the volume of the radiated structure are important in the appearance and evolution of this type of glaucoma. Topical treatment is usually ineffective, the preferable options being laser and surgical treatments. Although it is not a frequently seen pathology, it is important to know how to diagnose and treat this type of glaucoma. There are various options available for treatment, but choosing one is difficult because of the possible complications.
Topics: Antihypertensive Agents; Burns, Chemical; Cryotherapy; Eye Burns; Glaucoma, Open-Angle; Humans; Laser Coagulation; Radiation Injuries; Trabeculectomy
PubMed: 29450351
DOI: No ID Found -
European Annals of Otorhinolaryngology,... Oct 2017The nose is the central organ of the face. It has two essential roles, aesthetic and breathing. It is often seriously damaged in the context of facial burns, causing... (Review)
Review
The nose is the central organ of the face. It has two essential roles, aesthetic and breathing. It is often seriously damaged in the context of facial burns, causing grotesque facial disfigurement. As this disfigurement is visible on frontal and profile views, the patient suffers both socially and psychologically. The nose is a three-dimensional organ. Reconstruction is therefore more difficult and needs to be more precise than in other parts of the face. Maintaining symmetry, contour and function are essential for successful nasal reconstruction. Multiple factors determine the optimal method of reconstruction, including the size of the defect, its depth and its site. Satisfactory social life is recovered only after multiple surgical procedures and long-term rehabilitation and physiotherapy.
Topics: Burns; Burns, Chemical; Facial Injuries; Humans; Nose; Nose Deformities, Acquired; Patient Satisfaction; Plastic Surgery Procedures; Reoperation; Rhinoplasty; Surgical Flaps; Treatment Outcome
PubMed: 28336256
DOI: 10.1016/j.anorl.2017.02.014