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- Alkaline compounds cause saponification of the fatty acids in cell membranes, which penetrates the ocular surface epithelium as well as deeper cellular structures.
- Corneal and conjunctival epithelium, goblet cells, stromal keratocytes, corneal extracellular matrix, blood vessels, ciliary body and trabecular meshwork may be damaged.
- Immediate rise in the pH following alkaline solution exposure to eye.
- Symptoms: ocular pain, lacrimation, blepharospasm.
- In mild cases: epithelial erosion, mild corneal haze and conjunctival injection.
- In moderate cases: cornea may opacify with slight ischemia of limbus.
- In severe cases: significant ischemia of the sclera, avascularity of the limbus, blanching of conjunctiva and severe corneal haze.
- Eyelid scarring
- Corneal opacification, severe dry eye, corneal ulcer, perforation with potential secondary intraocular infection
- Conjunctival scarring, symblepharon or ankyloblepharon
- Aqueous dynamic changes with increased or decreased intraocular pressure
- Cataract and phthisis bulbi
- Immediate irrigation of eye until the pH of the cul-de-sac has returned to neutrality. (pH= 7.0)
- Remove foreign bodies and sweep fornices.
- Cycloplegic drops.
- Topical prophylactic broad-spectrum antibiotics.
- Topical steroid for I week to decrease the inflammatory response.
- Control of intraocular pressure.
- Insertion of methymethacrylate ring into cul-de-sac might prevent symblepharon and conjunctival fibrosis.
- Consider doxycycline for its collagenase inhibitor effect.
- Vitamin C 2 gram qid to promote collagen synthesis.
- During re-epithelialization phase:
- Intense lubrication with preservative free tear is essential
- Soft contact lens maybe helpful
- Patching or temporary tarsorraphy
- Surgical treatment:
- Limbal stem cell transplantation with or without amnioniotic membrane
- Conjunctival graft
- Corneal transplantation