Treating Thermal
Corneal Burns

BY WILLIAM TOWNSEND, O.D.
DEC. 1996

Many corneal and conjunctival burns are prevented by the blink reflex, but when thermal injury does occur, it's important to minimize the risk for infection, reduce pain and inflammation and promote rapid healing.

CASE 1: CURLING IRON

Sixteen-year-old Becky had been curling her hair with an electric curling iron which slipped across the apex of her right cornea, causing severe pain and blurred vision. Her presenting visual acuities were 20/40 OD and 20/20 OS. Slit lamp examination revealed a 3mm x 4mm area of clouded, edematous corneal epithelium. The margins of the burned cornea were loose and irregular. The anterior chamber showed trace cells and flare (Fig. 1).

FIG. 1: CLOUDED EDEMATOUS CORNEAL EPITHELIUM FOLLOWING A THERMAL CORNEAL BURN.

After instilling an anesthetic eye drop, we carefully debrided the burned area with a sterile spatula. The underlying tissue appeared slightly edematous, but showed no evidence of deeper damage. We cyclopleged the eye, instilled genta-micin drops and applied a bandage contact lens. We instructed Becky to take 400mg of ibuprofen by mouth every four hours. We explained the possibility of a secondary infection and the importance of reporting any increased pain or discomfort.

By the next morning, most of the damaged area had re-epithelialized, and there was no evidence of flare or cells. We prescribed gentamicin drops every six hours, gave her non-preserved artificial tears and instructed her not to rub her eye. At her last progress visit, Becky's best corrected visual acuity was 20/20 OU. Several years have passed and she has not had recurrent erosion, scarring or other complications.

CASE 2: MOLTEN PLASTIC

Eric, age 22, presented after a piece of molten plastic had flown into his eye. The plastic had dislodged from the corneal epithelium, and an area of burned edematous epithelium was centered over the visual axis. Visual acuity was 20/20 OU. We noted trace flare without cells in the anterior chamber of the injured eye and several burns on the superior and inferior eyelids.

We instilled proparacaine 0.5% and diclofenac sodium (Voltaren), and we carefully debrided the damaged tissue with a sterile Kimura spatula. The underlying tissue appeared undamaged, although we noted some stromal edema. We instilled a cycloplegic drop and tobramycin ointment, and applied a tight pressure patch. We told Eric to take 400mg of ibuprofen by mouth every six hours and to treat the eyelid burns with an OTC antibiotic ointment.

The next day, Eric had 20/20 vision bilaterally, and the damaged area had re-epithelialized. There was a faint ridge of tissue where the epithelial cells met. We instructed Eric to take Ocuflox drops four times a day for one week. We also warned him not to rub the eye and to report any increase in redness or pain that might suggest a secondary infection.

TREATMENT PROTOCOL

For thermal corneal burns, pretreat the eye with a topical NSAID to minimize pain, then debride the damaged tissue.

Treat the eye prophylactically with a broad spectrum antibiotic to reduce the risk of infection. The antibiotic should have good activity against Pseudomonas aeruginosa, an opportunistic bacteria that can be complicating in burn cases.

We've found that ibuprofen and other NSAIDs effectively alleviate the discomfort associated with these injuries. Oral acetaminophen is a good alternative for individuals who cannot take NSAIDs.

Strongly caution patients that rubbing the affected eye can damage or destroy the fragile epithelium that covers the traumatized area. If the burn is deeper than the epithelium, especially in the visual axis, refer the patient to a corneal specialist. These patients may require a partial or penetrating keratoplasty, depending on the severity and depth of the damage. The risk of secondary infection is high in these cases, so it's crucial that patients contact you immediately to report any increase in pain or injection. CLS

Dr. Townsend is in private practice in Canyon, Texas, and is a consultant at the Amarillo VA Medical Center.