published on August 23, 2016 by
On the date of examination, this kind 25 year old Filipino gentleman, who is a UCONN adjunct professor, presented for an emergency in reference to a chemical burn injury while helping his student with an experiment containing trifluoroacetic acid. While attempting to salvage the work, the pressure built up in the tubing and exploded into his right eye. He immediately flushed the eye under a Morgan Lens for several minutes to mitigate the acidic response. Subsequently, the infirmary contacted our office to see him on the same day to assess the status of his eye. On arrival, he wore dark sunglasses, was in tremendous pain, had light sensitivity, and his eye was sealed shut.
Upon examination, his visual acuity in the right eye was 20/30 with difficulty keeping the eye open. Additionally, slit lamp examination revealed two areas of epithelial and intrastromal central corneal defects measuring approximately 4 mm in size (~33-35% of the cornea) with no anterior chamber reaction and 1+-2 bulbar and palpebral conjunctival injection/hyperemia present. The pH was normalized with a reading of 7.0 before any drops were administered. Finally, there was no Seidel sign present to rule out whether the chemical compound had necrotized the tissue to cause a penetrating wound.
The patient was diagnosed with a significant chemical corneal burn for which two drops of Besivance (Besifloxacin 0.6%, B+L) were instilled in office to sterilize the ocular surface in the right eye. He was educated on the risks and benefits of amniotic membranes to ensure minimal to no scar tissue present in order to preserve his acuity in the short and long-term. As an aside, our practice has an electronic consent requirement to watch the PROKERA video from Rendia (Echo platform) describing the procedure on the iPad2 before placing the membrane on the eye, which I find to be very beneficial in educating patients. Once this was accomplished, a PROKERA Slim was successfully inserted in the right eye. He was given a prescription for Besivance 1 drop tid for preventive [and community standard] care.
On Day 2, the patient was more comfortable and upon slit lamp examination, 70-75% of the amniotic membrane was consumed. Interestingly, I was already able to articulate that there was less corneal opacification present. He was advised to continue his Besivance drops and return the following day for evaluation.
On Day 3, the patient mentioned that he did notice his visual acuity was improved and minimal discomfort. At the slit lamp, 75-80% of the amniotic membrane was consumed for which revealed no evidence of stromal corneal opacification or scar tissue. We advised the patient it was safe to remove the lens and continue the Besivance drops for four more days before discontinuation. Immediately after removing the lens, he did make an unsolicited comment on how clear his vision was post procedure.
The patient returned for a one-week follow up prior to leaving for Germany on sabbatical. His initial discussion centered on how happy and lucky he was to come away from the accident without a scar or visual loss. Furthermore, his visual acuity was 20/15 and there were no injurious corneal signs. He shook my hand several times before leaving and told me that his mother was elated to hear the news back in their home country of the Philippines.
Michael S. Cooper, OD is the Medical Optometrist/Chief of Contact Lens services at Windham Eye Group in Willimantic, CT. He specializes in anterior segment disease treating a variety of conditions including dry eye and lid diseases, allergy, and uveitis. He has published research, participated on expert ocular surface disease roundtables, and lectured domestically.