Ocular Burns and Chemical Injuries Clinical Presentation

Updated: Jun 14, 2019
  • Author: Joshua J Solano, MD, FAAEM, FACEP; Chief Editor: Gregory Sugalski, MD  more...
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Radiant energy burns

Thermal injuries most often result from direct contact with a hot object (eg, curling iron, cigarette). Although these burns can affect a large ocular surface area, they are usually superficial. Patients with superficial burns often complain of symptoms similar to a corneal abrasion. Common complaints include tearing, photophobia, or a foreign body sensation.

A heightened index of suspicion may be required in the case of burns from fire exposure, in that ocular burns might be overlooked in the setting of larger body burns. Burns to the cornea may occur with sparing of the eyelids because individuals may keep their eyes open as they try to escape a fire. A review of a single burn center's retrospective data showed that 5% of patients had concomitant ocular thermal ocular burns. [20]

Patients with ultraviolet (UV) burns usually have an obvious history, although it may not be readily apparent to the patient. The most common form of radiation burn is due to unprotected welding. Patients with so-called arc eye present several hours after exposure with painful, weeping eyes. Also common is a history of excessive exposure to sunlight (as with snow blindness or prolonged or frequent use of tanning booths).

Chemical burns

Chemical injuries usually result from a substance being sprayed or splashed in the face. [21] Alkali injuries occur more frequently than acid burns and are more detrimental.


Physical Examination

In the initial physical examination, assess for other potentially life-threatening injuries. The initial physical examination of the eye may be limited to the determination of pH level and evaluation of visual acuity. Topical ocular anesthetics may be used to facilitate the initial examination but should not delay irrigation.

After copious irrigation, a full ophthalmologic examination is required. This may reveal tearing, conjunctival injection, scleral injection, scleral blanching, corneal defects, corneal opacification, uveitis, glaucoma, or globe perforation. Decreased visual acuity may be noted. Fluorescein evaluation is needed to determine the extent of the injury. Repeat pH testing should be performed until normalization with copious irrigation. If pH fails to normalize, troubleshooting of pH paper should be attempted with pH testing of the examiner’s eye. With UV injuries, punctate keratitis may be noted. Lid eversion is necessary to evaluate for the presence of retained solid substances.