A 63-year-old male presented with decreased vision and pain after alkali chemical splash to both eyes at a utility plant. He presented with perilimbal ischemia in the right eye greater than the left, complete opacification of the right cornea and a large epithelial defect in the left. His pH was initially elevated, so he was copiously irrigated and started on topical antibiotics, steroids, and anti-hypertensives along with oral Vitamin C and doxycycline. He subsequently received 3 AMTs and subconjunctival triamcinolone in the right eye and 2 AMTs in the left eye with slow but consistent improvement in pain and vision. Ocular hypertension was initially controlled but then returned later in the course due to steroid response versus alkali damage. Early limbal stem cell deficiency as well as symblepharon have also become apparent. The patient will continue to need close monitoring for cicatricial sequelae, glaucoma, and corneal opacification due to LSCD. This presentation discusses epidemiology, classification, and the data behind basic medical and surgical management of alkali corneal burns. We also address controversies in treatment algorithms and the studies supporting them. Finally, we examine future directions for research in areas such as anti-TNF agents preventing cytokine-mediated damage not only of the anterior segment but of the posterior segment (retinal ganglion and optic nerve) as well.
Presentation Date: 08/15/2019
Issue Date: 08/01/2020