THE METHOD FOR SELECTING AN IRRIGATION SYSTEM FOR EMERGENCY TREATMENT OF PATIENTS AFTER CHEMICAL AND THERMAL EYE BURNS OF THE FIRST OR SECOND DEGREE WITH THE PREDOMINANT LESION OF THE EYELIDS OR CORNEA

Purpose — to develop a multidirectional  model  for detecting hidden  corneal  lesions  in patients after  chemical  and  thermal first or second degree burns  with predominant lesion of eyelid or cornea and  the  timely  emergency help with irrigation  systems.

Patients and  methods. 110  patients with thermal and  chemical  eye  burns  were  examined.  All  patients underwent a  detailed  clinical and comprehensive ophthalmological  examination. According  to  results they  were  divided into groups, depending  on  the  cause of the first and  second degree burn.  Group 1:  the  patients with thermal eye burn  (n = 45);  Group 2:  the  patients with chemical  eye burn (n = 41). Group 3:  the  patients after  an induced  chemical  burn  (alcohol deepithelization  with an 18%  alcohol solution in LASEK) (n = 27). Group 4:  healthy people  (n=25).  We  used  computer corneotopography, topography  of the  cornea and  analysis of anterior eye chamber, counting  the  number of endothelial  cells,  optical coherence tomography of the  anterior segment, confocal  microscopy, all tests were determined before  and after  treatment with irrigation systems.

Results. In cases of the I or II degrees chemical  burn with a predominant lesion of the cornea — irrigation system is for emergency treatment — a neutral  pH buffer solution is 4.9% phosphate salts, possessing amphoteric properties, neutralizing acids  and bases. In cases of the I or II degrees thermal burns  with predominant damage to the  eyelids and  conjunctiva — an irrigation system is sterile sodium  chloride solution 0.9 %.

Conclusions. The model of diagnostics and  treatment provides  high functional outcomes results in the  thermal and  chemical  burns  with predominant lesion of the eyelid or cornea with accurate timely diagnostics of the cornea and use  of optimal irrigation solutions  for emergency and targeted therapy.

1. Kuckelkorn R., Luft I., Kottek A.A.,Schrage N.F., Makropoulos W., Reim M. Chemical and thermal eye burns in the residential area of RWTH Aachen. Analysis of accidents in 1 year using a new automated documentation of findings. Klin Monatsbl Augenheilkd. 1993; 203(1):34‑42.

2. Nicaeus T., Erb C., Rohrbach M., Thiel H.J. An analysis of 148 outpatient treated occupational accidents. Klin Monatsbl Augenheilkd. 1996; 209(4):7‑11.

3. Blackburn J., Levitan E.B., MacLennan P.A., Owsley C., McGwin G. Jr. The epidemiology of chemical eye injuries. Curr Eye Res. 2012 Sep.;37(9):787‑93.

4. Pegg S.P., Miller P.M., Sticklen E.J., Storie W.J. Epidemiology of industrial burns in Brisbane. Burns Incl Therm Inj. 1986;12(7):484‑490.

5. Puchkovskaya N.A., Shulgina N.S.,. Minev N.G [Immunology of eye pathology]. Moscow, Medicina, 1983. (in Russ.).

6. Chentsova, O. B., Prokof 'eva, G. L., Ryabtseva, A. A., Luchkov, M. Yu., Mozherenkov, V. P., Grechanyy, M. P., Kravchenko, E. V. [Prevention of complications in damage to the eye]. [Almanac of Clinical Medicine]. Profilaktika oslozhneniy pri povrezhdeniyakh organa zreniya. Al’manakh klinicheskoy meditsiny. (in Russ.).

7. Ochirova E.K., Plekhanov A.N. [Medicamentous treatment of eye burns (review of literature)]. Medikamentoznoe lechenie ozhogov glaz (obzor literatury) [Bulletin of the East Siberian Scientific Center of the Siberian Branch of the Russian Academy of Medical Sciences]. Bjulleten’ Vostochno-Sibirskogo nauchnogo centra Sibirskogo otdelenija Rossijskoj akademii medicinskih nauk. 2010;3:364. (in Russ.).

8. Kochergin S.A., Sergeeva N.D. [Comparative analysis of quality of life and vision in patients with different types of eye trauma]. Sravnitel’nyj analiz pokazatelej kachestva zhizni i sostojanija zrenija u pacientov s raznymi tipami mehanicheskoj travmy glaza [Ophthalmology]. Oftal’mologija. 2012;9(3):77‑80.

9. Shiyanov O.V., Semenov V.A., Babkin V.B. [Features of medical care for burn injuries in the prehospital period]. Osobennosti okazanija medicinskoj pomoshhi pri ozhogovoj travme v dogospital’nom periode [Bulletin of new medical technologies: periodic theoretical and scientific and practical journal]. Vestnik novyh medicinskih tehnologij: periodicheskij teoreticheskij i nauchno-prakticheskij zhurnal. 2010;17(1):188‑191. (in Russ.).

10. Velevska M. A., Duma H., Trpevska N. Evaluation of corneal changes in chemical burns with anterior segment optical coherence tomography. South-East European journal of ophthalmology. 2015;1(1): 1–3. DOI: 10.1155/2014/196827

11. Pegg S.P., Miller P.M., Sticklen E.J., Storie W.J. Epidemiology of industrial burns in Brisbane. Burns Incl Therm Inj. 1986;12:484–490.

12. Le, Q. H., Wang, W. T., Hong, J. X., Sun, X. H., Zheng, T. Y., Zhu, W. Q., Xu, J. J. An in vivo confocal microscopy and impression cytology analysis of goblet cells in patients with chemical burns. Investigative ophthalmology & visual science. 2010;51(3):1397‑1400 DOI: 10.1167/iovs.09‑3886.

13. Chirskiy, V. S., Churashov, S. V., Zlobin, I. A., Rud’ko, A. S., Chernysh, V. F., Eliseeva, N. A., Solov’eva, T. S. [Determination of the outcomes of early conservative treatment of alkaline burns of the cornea and limbus of various extent using impression cytology in the experiment]. Opredelenie ishodov rannego konservativnogo lechenija shhelochnyh ozhogov rogovicy i limba razlichnoj protjazhennosti s ispol’zovaniem impressionnoj citologii v jeksperimente [Bulletin of Russian Military Medical Academy]. Vestnik rossiskoj voenno-medicinskoj akademii. 2016;1(53):131. (in Russ.).

14. Volkovich T.K., Samsonova I.V., Imshenetskaya T.A., Zalutskiy I.V. [Impressionic cytology: diagnostic capabilities in ophthalmology]. Impressionnaja citologija: diagnosticheskie vozmozhnosti v oftal’mologii [Russian children’s ophthalmology]. Rossijskaja detskaja oftal’mologija. 2016;1:46‑52. (in Russ.).

15. Zhivov A, Stave J, Vollmar B, Guthoff R. In vivo confocal microscopic evaluation of Langerhans cell density and distribution in the normal human corneal epithelium. Graefes Arch Clin Exp Ophthalmol. 2005;243(10):1056‑1061.

16. De Nicola R., Labbé A., Amar N., Dupas B., Baudouin C. In vivo confocal microscopy and ocular surface diseases: anatomical‑clinical correlations. J Fr Ophtalmol. 2005;28(7):691‑698.

17. Tsoulnaras, K. I., Liakopoulos, D. A., Grentzelos, M. A., Pallikaris, A. I., Mikropoulos, D. G., Kymionis, G. D. Confocal Microscopy and Anterior Segment Optical Coherence Tomography Findings After Chemical Alkali Corneal Burn. Cornea. 2016;35(10):32‑e35. DOI: 10.1097/ICO.0000000000000930

18. Birich T.V. [Eye burns]. Minsk, 1979. (in Russ.).

19. Gundorova, R. A., Makarov, P. V., Dadasheva, Z. R. [Treatment of the „dry eye“ syndrome with burn eye disease]..Lechenie sindroma «sukhogo glaza» pri ozhogovoy bolezni glaz. [Ophthalmology in Belarus: a scientific and practical journal]. Oftal‘mologiya v Belarusi: nauchno-prakticheskiy zhurnal. 2010;1(1):84‑89. (in Russ.).

20. Gundorova R.A., Bordyugova G.G., Travkin A.G. [Reconstructive surgery on the eyeball]. Moscow, Medicina, 1983. (in Russ.).

21. Kuckelkorn R., Makropoulos W., Kottek A., Reim M. Retrospective study of severe alkali burns of the eyes. Klin Monatsbl Augenheilkd. 1993;203:397–402.

22. Schrage N.F., Langefeld S., Zschocke J., Kuckelkorn R., Redbrake C., Reim M. Eye burns: an emergency and continuing problem. Burns. 2000;26:689–699.

23. Kompa S., Schareck B., Tympner J., Wüstemeyer H., Schrage N. F. Comparison of emergency eye‑wash products in burned porcine eyes. Graefe’s archive for clinical and experimental ophthalmology. 2002;240(4):308‑313.

24. Fatt I., Chaston J. The osmotic component of swelling under extended wear soft contact lenses. Optometry & Vision Science. 1981;58:429–434.

25. Wilson G., O’Leary D.J., Vaughan W. Differential swelling in compartments of the corneal stroma. Investigative ophthalmology & visual science. 1984;25:1105–1108.