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CASE REPORT
Year : 1984  |  Volume : 32  |  Issue : 4  |  Page : 231-233

Acid burns of cornea-unusual clinical course


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Correspondence Address:
S K Angra
Dr. Rajendra Prasad Centre for, Ophthalmic Sciences. Ansari Nagar, AIIM.S., New Delhi-110029
India
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Source of Support: None, Conflict of Interest: None


PMID: 6100925

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How to cite this article:
Angra S K, Chawdhary S, Zutshi R, Mohan M. Acid burns of cornea-unusual clinical course. Indian J Ophthalmol 1984;32:231-3

How to cite this URL:
Angra S K, Chawdhary S, Zutshi R, Mohan M. Acid burns of cornea-unusual clinical course. Indian J Ophthalmol [serial online] 1984 [cited 2019 Dec 7];32:231-3. Available from: http://www.ijo.in/text.asp?1984/32/4/231/27396

Strong acid burns though equally disastrous to the eye, are rarely seen in clinical practice than the alkali burnsl. Typical injury due to strong mineral acids is described as instan­taneous and non progressive as distinct from alkali burns where damage is diffuse and progressive[1],[2],[3],[4].

We report two unusual cases of mineral acid burns where the clinical course rese­mbled that of alkali burns. One of the cases was injured with Aqua regia, the strongest possible inorganic acid. We found no mention of such a clinical course caused by the injuries due to this agent in literature.

Case I:

A 31-year-old goldsmith was accidentally splashed in the face with a hot solution of 80% aqua regia. The local medical practitioner immediately washed his face and eyes with tap water. On presentation to our hospital 6 hours after the accident, the physical examination revealed 30% second degree and 20% third degree burns of the body surface. The brunt of injury was borne by the face and neck [Figure - 1]. Ocular examination revealed visual acuity of counting fingers at 1 1/ 2 meters in both eyes. The lids were covered with black eschar and conjunctivae were white and devoid of congestion. Cornea was hazy and lens partially opaque in both eyes. The pH of conjunctivae was 6.5 at that time and it needed continuous saline irrigation for 45 minutes to normalize the pH. The patient was taken up for escharectomy and primary skin grafting as an emergency procedure. He was put on systemic antibiotics and local antibiotic and cycloplegic ointment with local 3 hrly antibiotic drops. Next day and subsequent days the pH in conjunctival sacs was found 6.5 in both eyes and required repeated and prolonged saline irrigation for normalisation. Although his general condi­tion improved but the ocular condition wor­sened. On the 5th day the both corneae melted away and the iris and lenses prolapsed. No surgery could be done owing to the extreme fragility of the limbal tissues. Perception of light was lost in both eyes within 24 hours of perforation. Finally the eyes became phthisi­cal within a week [Figure - 2].

Case II:

Patient, a 42 years old male was splashed on the right side of his face with concentrated hydrochloric acid by an assailant. He washed his face with running tap water immediately and rushed to the local hospital where a saline wash was given in right eye and he was put on subconjunctival injections of Decadron and Genticyn twice a day, intensive local antibiotics, atropin eye ointment along with systemic antibiotics and acetazolamide. The condition deteriorated and he was referred to our hospital, after a week. On examination he had third degree burns of face. Visual acuity was: projection inaccurate in R/E and 6/6 in UE. His conjunctival pH was recorded as 6.5 in R/E on two occaasions on different days and it required repeated saline irrigation to normalise. There was limbal ischemia with peripheral corneal thinning [Figure - 3], which perforated the next day with the prolapse of iris. Despite medical treatment the eye condi­tion worened and it became phthisical finally.


  Discussion Top


Burns with strong acids produce instan­taneous cellular death and coagulation of protein and thus are sharply limited in extent to the area of contact and are non progressive in nature[1],[2],[3],[4]. This was not the case in the above two cases.

Aqua regia (heated mixture of one volume of concentrated nitric acid and three volumes of concentrated hydrochloric acid) is one of the strongest known acid. Its action is due to the libertation of free chloride ion and nitrosyl chloride[5].

Our first case illustrates the relentless course of burns caused by aqua regia. Rapid intraocular penetration and progressive nature of injury is suggested by cataractous lenses seen within 6 hours of injury, severe limbal ischaemia, sudden and bilateral perforation and melting away of cornea in both eyes. The pH of conjunctivae remained acidic long after the injury even after repeated and prolonged irrigation, indicating a slow acid release, which has not been emphasized in literature on acid burns.

In the second case similar features were seen after concentrated hydrochloric acid burns where severe limbal ischaemia with perforation occured after a week of injury with conjunctival pH found to be acidic repeatedly despite management.

In our cases the-perforation occured by the end of first week while in alkali burns of cornea it occurs by the third weeks. This is explained by the fact that the corneal perforation (aseptic necrosis of cornea) in these cases occurred early due to limbal ischaemia and weakening of the cornea due to eschar formation.

Both these cases resemble alkali burns, in pathogenesis as evidenced by rapid intrao­cular penetration and slow release of acid over prolonged intervals as indicated by repeated recordings of acidic pH of the con­junctival sac, limbal ischaemia and aseptic corneal perforation.


  Summary Top


Two cases of acid burns with unusual clini­cal course caused by strong inorganic acids are reported. The injury behaved clinically more like alkali burns in terms of intraocular damage, and slow continuous release of acid upto 5-7 days after injury despite repeated irrigations. Corneal perforation were identi­cal to those caused due to limbal ischaemia.

 
  References Top

1.
Duke Elder, S. and .MacFaul, P.A., 1972, System of Ophthalmology, vol. XIV injuries part 2. Henery Kimpton, London, p. 1055-1063.  Back to cited text no. 1
    
2.
Ralph,. R.A., 1981. Chemical burns of the eye in Clinical Ophthalmology vol.4 Thomas Duane (Ed.) Har­per and Row Publishers, Philadelphia, p. 1-22.  Back to cited text no. 2
    
3.
McCulley, J.P., 1983, Chemical Injuries in the Cornea-Scientific Foundation and Clincial practice. First Edition, Little Brwn and Company, Smolin, G. & Thoft, RA. (Ed.). Boston/Toronto, p. 422-438,  Back to cited text no. 3
    
4.
Goldberg, M.F. & Paton, D., 1980, Ocular Emergen­cies (2466-2469) in Principles and Practice of Ophthal­mology, Peyman, G.A.; Saunders D.R, Goldberg, M.F. (Editors). W.B. Saunders Co. Philadelphia/London, Toronto,  Back to cited text no. 4
    
5.
Hey, H., 1966, Kingzett's Tindall and Cassel Ltd. London, Ninth Edition p. 76.  Back to cited text no. 5
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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