بنام خداوند بخشنده مهربان

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Ocular thermal burns

Burns of the eyelid conjunctiva cornea sclera are considered ocular burns

Ocular burns classified by etiologic agents

Chemical injuries Radiant energy injuries heat

Radiation

Pathophisiology

Severity depend on 1- Exposure duration 2- Causative agent

Burns damage tissue by

1- Denaturing 2- Coagulating Cellular proteins causes vascular

ischemic damage

Thermal burns results from contact with hot liquidsHot gases Molten metals

Ocular burns represent 7-18% ocular traumas Vast majority ( 84%) are chemical Thermal burns are about 16%20% patients with facial burns exhibit ocular injury

The major concern with ocular burns is :

1- Final visual acuity 2- Cosmetic appearance

Eyelid burns are the most common complication of ocular burnsCorneal burns and abrasions Conjunctivitis Cataract Corneal perforation

Thermal burns generally have good visual out comes

Ocular burns are more common in males than in femalesStrong association of ocular burns among younger ages groups

Clinical findings

Most commonly are superficial Most commonly complain tearing Photophobia and F.B. sensation Corneal burns can occur with sparing of the eyelids because individuals may keep their eyes open as they try to escape of fire

The blink reflex protects the eyes from most burn injures Dermatitis of varying intensity may be cased by excessive heat on the skin

( Classified in four stages )

First degree

1- Aactive congestion of superficial blood vessels ( erythema )

2- Erythema followed by epidermal desquamation ( peeling )

3- No sequela

Second degree

1- Transudation of serum from the capillaries causes edema and vesicles and blebs

2- Complete recovery without scar formation

third degree

1- Burns are serious 2- Full thickness of the skin is involved 3- Skin appendages are also destroyed 4- No epithelium for regeneration 5- Healing leaves scar

Fourth degree

1- Burns distracted entire skin and subcutaneous fat and tendons

2- Both 3 & 4 degree burns need grafting for closures

Management of ocular burns

1- Immediate first aid for minor thermal burns consists of prompt cold application :

a: ice water b: cold tap water 2- Vesicles or blebs should not be opened but should

be protected from injury Vesicles are a natural barrier against contamination If the become tense and painful the fluid may be

evacuated under strictly aseptic conditions by puncturing with a needle

Bacterial and fungal infection are a serious complication in sever burns

Human amniotic membrane

Consists of 1- A thick collagen layer 2- Basement membrane 3- Epithelial layer

Human amniotic membrane

1- Contain low antigen activity against body immune system

2- Contain antibacterial and anti inflammatory effects so it prevents from scar tissue formation

3- It prevents new vessels formation

Indications

1- Severe dry eye with stem cell graft 2- Ocular pemphigoid3- Conjunctival flap in persistent corneal epithelial

defects 4- Ptergium 5- After removal of tumors 6- Ocular burns 7- Symblepharon 8- Ocular surface disorders 9- In lid surgery 10- Peripheral ulcerative keratitis 11- In bulus keratitis

Human placenta was obtained under sterile conditions from planned cesarean section After removal of adherent blood amniotic membrane was manually separated from the chorion Pieces of 2.5 × 5 cm .sutured on to sterile carrier membrane Carrier membrane is made of cellulose nitrate and should be keep in – 80 ْ of centigrade Epithelium side is up Amnio dry allow graft

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