Chemical burn of the cornea of the eye mkb 10. Thermal and chemical burns of the outer surfaces of the body

Date: 23.06.2020

RCHD (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Thermal and chemical burns, unspecified (T30)

general information

Short description

Thermal burns arise as a result of direct exposure to the skin of flame, steam, hot liquids and powerful heat radiation.

Chemical burns arise as a result of contact with the skin of aggressive substances, more often strong solutions of acids and alkalis, capable of causing tissue necrosis in a short time.

Protocol code: E-023 "Thermal and chemical burns of the outer surfaces of the body"
Profile: emergency

Stage goal: stabilization of vital body functions

Code (codes) for ICD-10-10: T20-T25 Thermal burns of the outer surfaces of the body, specified by their location

Included: thermal and chemical burns:

First degree [erythema]

Second degree [blisters] [loss of epidermis]

Third degree [deep underlying tissue necrosis] [loss of all layers of skin]

T20 Thermal and chemical burns of the head and neck

Included:

Eyes and other areas of the face, head and neck

Temple (area)

The scalp (any area)

Nose (septum)

Ear (any part)

Limited to eye and adnexa (T26.-)

Mouth and pharynx (T28.-)

T20.0 Thermal burns of head and neck, unspecified

T20.1 Thermal burns of head and neck, first degree

T20.2 Thermal second-degree head and neck burn

T20.3 Third-degree thermal burn of head and neck

T20.4Corrosion of head and neck, unspecified

T20.5 Chemical burns of head and neck, first degree

T20.6Chemical burn of the head and neck, second degree

T20.7Chemical burns of head and neck, third degree

T21 Thermal and chemical burns of the trunk

Included:

Lateral abdominal wall

Anus

Interscapular region

Breast

Groin area

Penis

Labia (large) (small)

Perineum

Backs (any part)

Chest wall

Abdominal walls

Gluteal region

Excludes: thermal and chemical burns:

Scapular region (T22.-)

Axillary cavity (T22.-)

T21.0 Thermal burn of torso, degree unspecified

T21.1 Thermal burn of torso, first degree

T21.2 Thermal second-degree burn of torso

T21.3 Third degree thermal burn of torso

T21.4Corrosion of torso, degree unspecified

T21.5 Chemical burn of trunk, first degree

T21.6 Chemical burn of torso, second degree

T21.7 Third-degree chemical burn of trunk

T22 Thermal and chemical burns of the shoulder girdle and upper limb, excluding the wrist and hand

Included:

Scapular region

Axillary area

Hands (any part other than just the wrist and hand)

Excludes: thermal and chemical burns:

Interscapular region (T21.-)

Wrists and hands only (T23.-)

T22.0 Thermal burn of shoulder and upper limb, excluding wrist and hand, degree unspecified

T22.1 Thermal burn of shoulder girdle and upper limb, excluding wrist and hand, first degree

T22.2 Thermal burn of shoulder girdle and upper limb, excluding wrist and hand, second degree

T22.3 Thermal burn of shoulder girdle and upper limb, excluding wrist and hand, third degree

T22.4Corrosion of the shoulder girdle and upper limb, excluding wrist and hand, degree unspecified

T22.5 Chemical burn of shoulder girdle and upper limb, excluding wrist and hand, first degree

T22.6 Chemical burn of shoulder girdle and upper limb, excluding wrist and hand, second degree

T22.7 Chemical burn of shoulder girdle and upper limb, excluding wrist and hand, third degree

T23 Thermal and chemical burns of wrist and hand

Included:

Thumb (nail)

Finger (nail)

T23.0 Thermal burn of wrist and hand, degree unspecified

T23.1 Thermal burn of wrist and hand, first degree

T23.2 Thermal second-degree burn of wrist and hand

T23.3 Third-degree thermal burn of wrist and hand

T23.4Corrosion of unspecified degree of wrist and hand

T23.5 Chemical burns of wrist and hand, first degree

T23.6 Chemical burn of wrist and hand, second degree

T23.7 Third-degree chemical burns of wrist and hand

T24 Thermal and chemical burns of the hip joint and lower limb, excluding the ankle and foot

Includes: legs (any part except ankle and foot)

Excludes: thermal and chemical burns of ankle and foot only (T25.-)

T24.0 Thermal burn of hip and lower limb, excluding ankle and foot, degree unspecified

T24.1 Thermal burn of hip and lower limb, excluding ankle and foot, first degree

T24.2 Thermal burn of hip and lower limb, excluding ankle and foot, second degree

T24.3 Thermal burn of hip and lower limb, excluding ankle and foot, third degree

T24.4Chemical burn of the hip joint and lower limb, excluding the ankle and foot, degree unspecified

T24.5 Chemical burn of the hip joint and lower limb, excluding the ankle and foot, first degree

T24.6 Chemical burn of hip joint and lower limb, excluding ankle and foot, second degree

T24.7Chemical burn of the hip joint and lower limb, excluding ankle and foot, third degree

T25 Thermal and chemical burns of the ankle joint and foot

Includes: toe (s)

T25.0 Thermal burn of ankle and foot, degree unspecified

T25.1 Thermal burn of ankle and foot, first degree

T25.2 Thermal burn of ankle and foot, second degree

T25.3 Third degree thermal burn of ankle and foot

T25.4Corrosion of ankle and foot, degree unspecified

T25.5 Chemical burn of ankle and foot, first degree

T25.6 Chemical burn of ankle and foot, second degree

T25.7 Third-degree chemical burn of ankle and foot

THERMAL AND CHEMICAL BURNS OF MULTIPLE AND UNRECISED LOCALIZATION (T29-T32)

T29 Thermal and chemical burns of several areas of the body

Includes: thermal and chemical burns classified under more than one of the headings T20-T28

T29.0 Thermal burns of several areas of body, degree unspecified

T29.1 Thermal burns of several areas of the body, indicating no more than first degree burns

T29.2 Thermal burns of several areas of the body, indicating no more than second degree burns

T29.3 Thermal burns of multiple areas of the body, indicating at least one third degree burn

T29.4 Chemical burns of several areas of the body, degree unspecified

T29.5 Chemical burns of several areas of the body, indicating no more than the first degree of chemical burns

T29.6 Chemical burns of several areas of the body, indicating no more than second degree chemical burns

T29.7 Chemical burns of several areas of the body, indicating at least one third degree chemical burn

T30 Thermal and chemical burns, unspecified

Excludes: thermal and chemical burns with a specified area of the affected

Body surfaces (T31-T32)

T30.0 Thermal burn, degree unspecified, unspecified

T30.1 Thermal burn of the first degree, unspecified

T30.2 Thermal second degree burn, unspecified

T30.3 Thermal third degree burn, unspecified

T30.4 Chemical burn of unspecified degree of unspecified localization

T30.5 Chemical burn of the first degree, unspecified localization

T30.6 Chemical burn of the second degree, unspecified localization

T30.7Chemical burn of the third degree, unspecified

T31 Thermal burns classified according to the area of the affected body surface

Note: This heading should be used for primary statistical development only in cases where the location of the thermal burn is not specified; if localization is specified, this heading can be used as an additional code with headings T20-T29 if necessary

T31.0 Thermal burn less than 10% of body surface

T31.1 Thermal burn of 10-19% of body surface

T31.2 Thermal burn of 20-29% of body surface

T31.3 Thermal burn of 30-39% of body surface

T31.4 Thermal burn 40-49% of body surface

T31.5 Thermal burn 50-59% of body surface

T31.6 Thermal burn 60-69% of body surface

T31.7 Thermal burn of 70-79% of body surface

T31.8 Thermal burn of 80-89% of body surface

T31.9 Thermal burn of 90% of body surface or more

T32 Chemical burns classified according to the area of the affected body surface

Note: This heading should be used for primary development statistics only in cases where the location of the chemical burn is not specified; if localization is specified, this heading can be used as an additional code with headings T20-T29 if necessary

T32.0 Chemical burn less than 10% of body surface

T32.1 Chemical burns 10-19% of body surface

T32.2 Chemical burn of 20-29% of body surface

T32.3 Chemical burn of 30-39% of body surface

T32.4 Chemical burn 40-49% of body surface

T32.5 Chemical burn 50-59% of body surface

T32.6 Chemical burn 60-69% of body surface

T32.7 Chemical burn of 70-79% of body surface

T31.8 Chemical burn 80-89% of body surface

T32.9 Chemical burn of 90% of body surface and more

Classification

The severity of local and general manifestations of burns depends on the depth of tissue damage and the area of the affected surface.

There are the following degrees of burns:

Burns of the 1st degree - persistent hyperemia and skin infiltration.

Second degree burns - peeling of the epidermis and blistering.

Burns of IIIa degree - partial necrosis of the skin with preservation of the deep-lying layers of the dermis and its derivatives.

Burns of IIIb degree - death of all skin structures (epidermis and dermis).

Burns of the IV degree - necrosis of the skin and deep-lying tissues.

Determination of the area of the burn:

1. "Rule of Nine".

2. Head - 9%.

3. One upper limb - 9%.

4. One bottom surface - 18%.

5. Front and back surfaces of the body - 18% each.

6. Genitals and perineum - 1%.

7. Rule of "palm" - conventionally, the area of the palm is approximately 1% of the total surface area of the body.

Factors and risk groups

1. The nature of the agent.

2. Conditions for getting a burn.

3. The time of exposure to the agent.

4. The size of the burn surface.

5. Multi-factor damage.

6. Ambient temperature.

Diagnostics

Diagnostic criteria

The depth of the lesion in a burn is determined based on the following clinical signs.

1st degree burns are manifested by hyperemia and swelling of the skin, as well as a burning sensation and pain. Inflammatory changes disappear within a few days, the superficial layers of the epidermis slough off, and by the end of the first week, healing begins.

Second degree burns accompanied by severe edema and flushing of the skin with the formation of blisters filled with yellowish exudate. Under the epidermis, which can be easily removed, there is a bright pink, painful wound surface. For chemical burns of the II degree, the formation of bubbles is not typical, since the epidermis is destroyed, forming a thin necrotic film, or is completely rejected.

For burns of IIIa degree at first, either a dry light brown scab is formed (with burns by a flame), or a whitish-gray moist scab (exposure to steam, hot water). Sometimes thick-walled blisters filled with exudate form.

With burns of IIIb degree dead tissues form a scab: in case of flame burns - dry, dense, dark brown in color; for burns with hot liquids and steam - pale gray, soft, doughy consistency.

IV degree burns accompanied by the death of tissues located under its own fascia (muscles, tendons, bones). The scab is thick, dense, sometimes with signs of charring.

At deep acid burns usually a dry, dense scab is formed (coagulation necrosis), and when alkali is damaged, the scab is soft (colliquation necrosis), gray in color for the first 2-3 days, and later it undergoes purulent fusion or dries out.

Electric burns almost always deep (IIIb-IV degree). Tissues are damaged at the points of current entry and exit, on the contacting surfaces of the body along the path of the shortest current passage, sometimes in the grounding zone, the so-called "current marks", which look like whitish or brown spots, in the place of which a dense scab forms, as if depressed in relation to to the surrounding intact skin.

Electrical burns are often combined with thermal burns caused by an electric arc flash, clothing ignition.

List of main diagnostic measures:

1. Collection of complaints, general therapeutic anamnesis.

2. General therapeutic visual examination.

3. Measurement of blood pressure in peripheral arteries.

4. Study of the pulse.

5. Measurement of heart rate.

6. Measurement of respiration rate.

7. Palpation is general therapeutic.

8. General therapeutic percussion.

9. General therapeutic auscultation.

List of additional diagnostic measures:

1. Pulse oximetry.

2. Registration, interpretation and description of the electrocardiogram.

Differential diagnosis

Differential diagnosis is based on an assessment of local clinical signs. It is rather difficult to determine the depth of the lesion, especially in the first minutes and hours after the burn, when there is an external similarity of the various degrees of the burn. Consideration must be given to the nature of the agent and the conditions of injury. Absence of a painful reaction when pricked with a needle, pulling out hair, touching a burnt surface with an alcohol swab; the disappearance of the "game of capillaries" after a short-term finger pressure indicate that the lesion is not less than IIIb degree. If there is a pattern of saphenous thrombosed veins under the dry scab, then the burn is reliably deep (IV degree).

With chemical burns, the boundaries of the lesion are usually clear, streaks are often formed - narrow stripes of affected skin extending from the periphery of the main focus. The appearance of the burn site depends on the type of chemical. In case of burns with sulfuric acid, the scab is brown or black, nitric - a yellow-green hue, hydrochloric - light yellow. In the early stages, the smell of the substance that caused the burn can also be felt.

Treatment

Treatment tactics

The aim of the treatment is to stabilize the vital functions of the body.First of all, it is necessary to stop the action of the damaging agent and removeinjured from the area of exposure to heat radiation, smoke, toxic productsburning. This is usually done before the arrival of the ambulance. Soaked in hotclothing should be discarded immediately.

Local hypothermia (cooling) of burnt tissue immediately after cessationthe action of a thermal agent promotes a rapid decrease in interstitialtemperature, which weakens its damaging effect. For this there may beused water, ice, snow, special cooling bags, especially whenlimited area burns.

In case of chemical burns after removing clothing soaked in chemicalsubstance, and abundant washing for 10-15 minutes (with late treatment, do notless than 30-40 minutes) of the affected area with a large amount of cold flowingwater, start using chemical neutralizers that increasethe effectiveness of first aid. Then apply dryaseptic dressing.

Striking agent	Neutralization means
Lime	Lotions with 20% sugar solution
Carbolic acid	Dressings with glycerin or milk of lime
Chromic acid	Dressing with 5% sodium thiosulfate solution *
Hydrofluoric acid	Dressings with a 5% solution of aluminum carbonate or a mixture of glycerin and magnesium oxide
Borohydride compounds	Dressing with ammonia
Selenium oxide	Dressings with 10% sodium thiosulfate solution *
Aluminum-organic connections	Rubbing the affected surface with gasoline, kerosene, alcohol
White phosphorus	Dressing with 3-5% copper sulfate solution or 5% solution potassium permanganate *
Acid	Sodium bicarbonate *
Alkalis	1% acetic acid solution, 0.5-3% boric acid solution *
Phenol	40-70% ethyl alcohol *
Chromium compounds	1% hyposulfite solution
Mustard gas	2% chloramine solution, calcium hypochlorite *

In case of thermal damage, clothes are not removed from the burned areas, but cut and carefully removed. After that, a bandage is applied, and in its absence any clean cloth is used. Do not clean before applying the dressingburnt surface from adhered clothes, remove (pierce) bubbles.

To relieve pain, especially with extensive burns, victimsSedatives must be administered - diazepam * 10 mg-2.0 ml IV (seduxen, elenium, relanium,sibazon, valium), painkillers - narcotic analgesics (promedol(trimepiridine hydrochloride) 1% -2.0 ml, morphine 1% -2.0 ml, fentanyl 0.005% -1.0 ml i.v.),and in their absence, any pain relievers (baralgin 5.0 ml i.v., analgin 50% -2.0 i.v., ketamine 5% - 2.0 * ml i.v.) and antihistamines - diphenhydramine 1% -1.0ml * i / v (diphenhydramine, diprazine, suprastin).

If the patient does not have nausea, vomiting, even if he does not have thirst, it is necessaryconvince to drink 0.5-1.0 liters of liquid.

Seriously ill with burns with a total area of more than 20% of the body surface,immediately begin infusion therapy: intravenous jet glucose-salinesolutions (0.9% sodium chloride solution *, trisol *, 5-10% glucose solution *), in volume,providing stabilization of hemodynamic parameters.

Indications for hospitalization:
- 1st degree burns over 15-20% of the body surface;

Second degree burns on an area of more than 10% of the body surface;
- IIIa degree burns on the areamore than 3-5% of the body surface;
- burns of IIIb-IV degree;
- burns of the face, hands, feet,perineum;
- chemical burns, electrical injury and electrical burns.

All victims in a state of burn shock with severe

3. * Sodium thiosulfate 30% -10.0 ml, amp.

4. * Ethyl alcohol 70% -10.0, fl.

5. * Boric acid 3% -10.0 ml, fl.

6. * Calcium hypochlorite, pore

7. * Fentanyl 0.005% -1.0 ml, amp.

8. * Morphine 1% -1.0 ml, amp.

9. * Sibazon 10 mg-2.0 ml, amp.

10. * Glucose 5% -500.0 ml, fl.

11. * Trisol - 400.0 ml, fl.

* - drugs included in the list of essential (vital) medicines.

Information

Sources and Literature

Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of 28.12.2007)
1. 1. Clinical guidelines based on evidence-based medicine: Per. from English / Ed. Yu.L. Shevchenko, I.N. Denisov, V.I. Kulakova, R.M. Khaitova. 2nd ed., Rev. - M .: GEOTAR-MED, 2002. - 1248 p .: ill. 2. Guidelines for emergency doctors / Ed. V.A. Mikhailovich, A.G. Miroshnichenko - 3rd edition, revised and enlarged - SPb .: BINOM. Knowledge laboratory, 2005.-704p. 3. Management tactics and emergency medical care in case of emergency. A guide for doctors. / A.L. Vertkin - Astana, 2004.-392s. 4. Birtanov E.A., Novikov S.V., Akshalova D.Z. Development of clinical guidelines and protocols for diagnosis and treatment, taking into account modern requirements. Guidelines. Almaty, 2006, 44 p. 5. Order of the Minister of Health of the Republic of Kazakhstan dated December 22, 2004 No. 883 “On approval of the List of essential (vital) medicines”. 6. Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2005 No. 542 "On amendments and additions to the order of the Ministry of Health of the Republic of Kazakhstan dated December 7, 2004 No. 854" On approval of the Instruction for the formation of the List of essential (vital) medicines. "

Information

Head of the Department of Emergency and Emergency Medical Care, Internal Medicine No. 2, Kazakh National Medical University named after S. D. Asfendiyarova - Doctor of Medical Sciences, Professor Turlanov K.M.

Employees of the Department of Emergency and Emergency Medical Care, Internal Diseases No. 2 of the Kazakh National Medical University named after S. D. Asfendiyarova: Ph.D., associate professor V.P. Vodnev; Candidate of Medical Sciences, Associate Professor Dyusembaev B.K .; Candidate of Medical Sciences, Associate Professor Akhmetova G.D .; Candidate of Medical Sciences, Associate Professor Bedelbaeva G.G .; Almukhambetov M.K .; Lozhkin A.A .; Madenov N.N.

Head of the Department of Emergency Medicine of the Almaty State Institute for Advanced Training of Doctors - Candidate of Medical Sciences, Associate Professor Rakhimbaev R.S.

Employees of the Department of Emergency Medicine of the Almaty State Institute for Advanced Training of Doctors: Candidate of Medical Sciences, Associate Professor Silachev Yu.Ya .; Volkova N.V .; Khairulin R.Z .; Sedenko V.A.

Attached files

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RCHD (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Thermal and chemical burns limited to the area of the eye and its adnexa (T26)

Ophthalmology

general information

Short description

Recommended
Expert Council
RSE on PVC "Republican Center for Health Development"
Ministry of Health
and social development
dated October 15, 2015
Protocol No. 12

Burns limited to the area of the eye and its adnexa- This is damage to the eyeball and tissues around the eye due to chemical, thermal and radiation damaging agents.

Protocol name: Thermal and chemical burns limited to the area of the eye and its adnexa.

ICD-10 code (s):

T26.0 Thermal burn of eyelid and periorbital region
T26.1 Thermal burns of cornea and conjunctival sac
T26.2 Thermal burn leading to rupture and destruction of eyeball
T26.3 Thermal burns of other parts of the eye and its adnexa
T26.4 Thermal burn of eye and its adnexa, unspecified
T26.5 Chemical burn of eyelid and periorbital region
T26.6 Chemical burns of cornea and conjunctival sac
T26.7 Chemical burn, leading to rupture and destruction of eyeball
T26.8 Chemical burns of other parts of the eye and its adnexa
T26.9Chemical burn of eye and its adnexa, unspecified

Abbreviations used in the protocol:
ALT - alanine aminotransferase

AST - aspartate aminotransferase
IV - intravenous
IM - intramuscularly
GKS - glucocorticosteroids
INR - international normalized ratio
P \ b - parabulbar
P \ to - subcutaneously
PTI - prothrombin index
UD - level of evidence
ECG - electrocardiographic examination

Date of development / revision of the protocol: 2015 year.

Protocol users: general practitioners, pediatricians, general practitioners, ophthalmologists.

Evaluation of the degree of evidence of the recommendations.
Evidence level scale:

Level evidence	Type of Evidence
	The evidence comes from a meta-analysis of a large number of well-designed randomized trials. Randomized trials with low false-positive and false-negative error rates.
	Evidence is based on the results of at least one well-designed, randomized trial. Randomized studies with high false-positive and false-negative error rates
III	Evidence is based on well-designed, non-randomized trials. Controlled studies with one patient group, studies with a historical control group, etc.
	Evidence comes from non-randomized trials. Indirect comparative, descriptive correlation studies and case studies
V	Evidence based on clinical cases and examples

Classification

Clinical classification
Depending on the influencing factor:
· Chemical;
· Thermal;
· Beam;
· Combined.

By anatomical localization of lesions:
Auxiliary organs (eyelids, conjunctiva);
· The eyeball (cornea, conjunctiva, sclera, deep-lying structures);
· Several adjacent structures.

According to the severity of damage:
· I degree - easy;
· II degree - medium degree;
III (a and b) degrees - severe;
· IV degree - very severe.

Diagnostics

List of basic and additional diagnostic measures:
Diagnostic measures carried out at the stage of an ambulance emergency:
· Collection of anamnesis and complaints.
Basic (mandatory) diagnostic examinations carried out at the outpatient level:
· Visometry (UD - S);
Ophthalmoscopy (UD - C);

· Biomicroscopy of the eye (UD - C).
Additional diagnostic examinations carried out at the outpatient level:
Perimetry (UD - C);
Tonometry (UD - C);
· Echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C);

Basic (mandatory) diagnostic examinations carried out at the inpatient level during emergency hospitalization and after more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
· Collection of complaints, medical history and life;
· general blood analysis;
· general urine analysis;
· Biochemical blood test (total protein, its fractions, urea, creatinine, bilirubin, ALT, AST, electrolytes, blood glucose);
· Coagulogram (PTI, fibrinogen, FA, clotting time, INR);
· Microreaction;
· Blood test for HIV by ELISA;
· Determination of HBsAg in blood serum by ELISA method;
· Determination of total antibodies to hepatitis C virus in blood serum by ELISA method;
· Determination of the blood group according to the ABO system;
· Determination of the Rh factor of blood;
· Visometry (UD - S);
Ophthalmoscopy (UD - C);
· Determination of defects in the surface of the cornea (UD - C);
· Biomicroscopy of the eye (UD - C);
ECG.
Additional diagnostic examinations carried out at the inpatient level during emergency hospitalization and after more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
Perimetry (UD - C);
Tonometry (UD - C);
· Echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C) *;
X-ray of the orbit (if there are signs of combined damage to the eyelids, conjunctiva and eyeball, to exclude foreign bodies) (UD - C).

Diagnostic criteria for the diagnosis:
Complaints and anamnesis
Complaints:
· Pain in the eye;
Lacrimation;
· Pronounced photophobia;
Blepharospasm;
· Decreased visual acuity.
Anamnesis:
· Clarification of the circumstances of the eye injury (type of burn, type of chemical).

Instrumental research:
· Visometry - decreased visual acuity;
· Biomicroscopy - violation of the integrity of the structures of the eyeball, depending on the severity of the damage;
Ophthalmoscopy - weakening of the reflex from the fundus;
· Determination of defects in the surface of the cornea - the area of damage to the cornea, depending on the severity of the burn;

Indications for consultation of narrow specialists:
· Consultation of a therapist - to assess the general condition of the body.

Differential diagnosis

Differential diagnosis.
Table - 1. Differential diagnosis of eye burns by severity

Degree of burn	Leather	Cornea	Conjunctiva and sclera
I	hyperemia of the skin, superficial exfoliation of the epidermis.	islet staining with fluorescein, dull surface	hyperemia, islet staining
II	blistering, peeling of the entire epidermis.	easily removable film, de-epithelialization, continuous staining.	pallor, gray films that are easily removed.
III a	necrosis of the surface layers of the skin itself (up to the growth layer)	superficial opacity of the stroma and Bowman's membrane, folds of the Descemet's membrane (if its transparency is preserved).	pallor and chemosis.
III in	necrosis of the entire thickness of the skin	deep opacity of the stroma, but without early changes in the iris, a sharp violation of sensitivity on the limbus.	exposure and partial rejection of the pallid sclera.
IV	deep necrosis of not only skin, but also subcutaneous tissue, muscles, cartilage.	simultaneously with changes in the cornea up to the detachment of the Descemet shell ("porcelain plate"), depigmentation of the iris and immobility of the pupil, clouding of moisture in the anterior chamber and lens.	melting of the naked sclera to the vascular tract, clouding of the moisture of the anterior chamber and lens, vitreous body.

Table - 2. Differential diagnosis of chemical and thermal eye burns

The nature of the damage	Alkaline burn	Acid burn
type of damage	colliquation necrosis	coagulation necrosis
intensity of primary corneal opacity	poorly expressed	pronounced strongly
depth of damage	corneal opacity does not match the depth of tissue damage	corneal opacity corresponds to the depth of tissue damage
damage to the cavity structures of the eye	swift	slow
development of iridocyclitis	swift	slow
neutralizers	2% boric acid solution	3% solution of bicarbonate of soda

Treatment

Treatment goals:
· Reduction of the inflammatory response of eye tissues;
· Relief of pain syndrome;
· Restoration of the surface (epithelialization) of the eye.

Treatment tactics:
For burns of the 1st degree - treatment is carried out on an outpatient basis, under the supervision of an ophthalmologist;
With burns of II-IV degrees - emergency hospitalization is indicated.

Drug treatment:
Medical treatment provided at the stage of emergency emergency care:

Medical treatment provided on an outpatient basis (for burnsI degree):
· If there is a powdery chemical substance or its pieces on the eyelids and conjunctiva, remove it with damp cotton wool or gauze;
Local anesthetics (oxybuprocaine 0.4% or proxymethacaine 0.5%) 1-2 drops into the conjunctival cavity once (UD - C);
· Abundant, prolonged (at least 20 minutes), rinsing of the conjunctival cavity with cool (12 0 -18 0 C) running water or water for injection (while washing the patient's eyes must be open);

Mydriatics (the choice of drugs remains at the discretion of the doctor) - cyclopentolate 1%, tropicamide 1%, phenylephrine ophthalmic 2.5% and 10% epibulbar, 1-2 drops up to 3 times a day for 3-5 days in order to prevent the development of inflammatory process in the anterior section of the vascular tract (UD - C);

Inpatient drug treatment:
BurnsIIdegree:
Local anesthetics (oxybuprocaine 0.4% or proxymethacaine 0.5%) in the form of instillations before flushing the conjunctival cavity, immediately before surgery, pain relief if necessary (LE - C);
With a chemical burn, abundant, prolonged (at least 20 minutes), continuous irrigation of the conjunctival cavity with a neutralizer for alkalis (2% boric acid solution or 5% citric acid solution or 0.1% lactic acid solution or 0.01% acetic acid solution), for acids ( 2% sodium bicarbonate solution). Chemical neutralizers are used during the first hours after a burn; later, the use of these drugs is impractical and can have a damaging effect on burned tissues (UD - C);
· In case of thermal burns, rinsing with cool (120-180C) running water / water for injection (while washing the patient's eyes must be open).
· Washing is not carried out with a thermochemical burn when a penetrating wound is detected;
Local antibacterial agents (chloramphenicol ophthalmic 0.25% or ciprofloxacin ophthalmic 0.3% or ofloxacin ophthalmic 0.3%) - for children over 1 year old and adults immediately after washing the conjunctival cavity, as well as 1 drop 4 times a day epibulbar within 5-7 days (for the prevention of infectious complications) (UD - C);
Antibacterial agents for local external use (ofloxacin ophthalmic 0.3% or tobramycin 0.3%) - for children over 1 year old and for adults 2-3 times a day on the burn surface (according to indications) (UD - C);
Non-steroidal anti-inflammatory drugs (diclofenac ophthalmic 0.1%) - 1 drop 4 times a day epibulbar (in the absence of epithelial defects) for 8-10 days. (UD - S);
Mydriatics - eye atropine 1% (adults), 0.5%, 0.25%, 0.125% (children) 1 drop 1 time per day epibulbarno, cyclopentolate 1%, tropicamide 1%, phenylephrine eye 2.5% and 10% epibulbar, 1-2 drops up to 3 times a day for the prevention and treatment of the inflammatory process in the anterior vascular tract (UD - C);
· Regeneration stimulants, keratoprotectors (dexpanthenol 5 mg) - 1 drop 3 times a day epibulbar. In order to improve the trophism of the anterior surface of the eyeball, to accelerate the healing of erosions (UD - C);
· With an increase in intraocular pressure: non-selective "B" blockers (timolol 0.25% and 0.5%) -. Contraindicated in: bronchial obstruction, bradycardia less than 50 beats per minute, systemic hypotension; Carbonic anhydrase inhibitors (dorzolamide 2%, or brinzolamide 1%) - epibulbar 1 drop 2 times a day (UD - C);
For pain - analgesics (ketorolac 1 ml IM) as needed (UD - C);

BurnsIII- IVdegree(additionally assigned to the above):
Anti-tetanus serum 1500-3000 IU s / c to reduce intoxication with contamination of a burn wound;
Non-steroidal anti-inflammatory drugs - diclofenac by mouth, 50 mg 2-3 times a day before meals, the course is 7-10 days (UD - C);
GCS (dexamethasone 0.4%) p / b 0.5 ml daily / every other day (not earlier than 5-7 days - according to indications, not in the acute phase of triamcinolone 4% 0.5 ml p / b 1 time). With anti-inflammatory, anti-edematous, anti-allergic, anti-exudative purpose (UD - C);
Antibacterial drugs (according to indications for severe burns in 1 and 2 stages of burn disease) enteral / parenteral - azithromycin 250 mg, 500 mg - 1 TB 2 times a day for 5-7 days, 0.5 or 0.25 ml i / v 1 once a day for 3 days; cefuroxime 750 mg 2 times a day for 5-7 days, ceftriaxone 1.0 IV 1 time a day for 5-7 days (EL - C).

Non-drug treatment:
· General mode II-III, table number 15.

Surgical intervention:
Surgical interventions for eye burnsIII- IV stages:
· Conjunctivotomy;
· Necrectomy of the conjunctiva and cornea;
Blepharoplasty, blepharorrhaphy;
· Layer-by-layer and through keratoplasty, corneal bio-covering.

Inpatient surgery:

Conjunctivotomy(ICD-9: 10.00, 10.10, 10.33, 10.99) :
Indications:
· Pronounced conjunctival edema;
· Risk of limbal ischemia.
Contraindications:
· General somatic status.

Necrectomy of the conjunctiva and cornea(ICD-9: 10.31, 10.41, 10.42, 10.43, 10.44, 10.49, 10.50, 10.60, 10.99, 11.49).
Indications:
· the presence of foci of necrosis.
Contraindications:
· General somatic status.

Blepharoplasty(early primary), blepharorrhaphy(ICD-9: 08.52, 08.59, 08.61, 08.62, 08.64, 08.69, 08.70, 08.71, 08.72, 08.73, 08.74, 08.89, 08.99):
Indications:
· Severe burn injuries of the eyelids, with the impossibility of complete closure of the palpebral fissure;
Contraindications:
· General somatic status.

Layered / penetrating keratoplasty, corneal bio-coating(ICD-9: 11.53, 11.59, 11.61, 11.62, 11.63, 11.64, 11.69, 11.99).
Indications:
· Threat of perforation / perforation of the cornea, with a therapeutic and organ-preserving purpose.
Contraindications:
· General somatic status.

Further management:
In case of mild burns, outpatient treatment under the supervision of an outpatient ophthalmologist;
After the end of inpatient treatment, the patient is admitted to the dispensary registration to an ophthalmologist at the place of residence (up to 1 year) with the necessary recommendations (volume and frequency of dispensary examinations).
· Reconstructive surgery (not earlier than a year after the injury) - plastic surgery of the eyelids, conjunctival cavity, keratoprosthetics, keratoplasty.

Treatment effectiveness indicators:
· Relief of the inflammatory process;
· Complete epithelialization of the cornea;
· Restoration of the transparency of the cornea;
· Increase in visual functions;
· Absence of cicatricial changes in the eyelid and conjunctiva;
· Absence of secondary complications;
· The formation of vascularized corneal leucorrhoea.

Preparations (active ingredients) used in the treatment

Azithromycin (Azithromycin)
Atropine
Boric acid
Brinzolamide
Dexamethasone
Dexpanthenol
Diclofenac (Diclofenac)
Dorzolamide
Ketorolac (Ketorolac)
Citric acid
Lactic acid
Sodium hydrocarbonate
Oxybuprocaine
Ofloxacin
Proxymetacaine
Serum tetanus (Serum tetanus)
Timolol (Timolol)
Tobramycin (Tobramycin)
Tropikamid (Tropikamid)
Acetic acid
Phenylephrine
Chloramphenicol
Ceftriaxone
Cefuroxime
Cyclopentolate
Ciprofloxacin (Ciprofloxacin)

Hospitalization

Indications for hospitalization with an indication of the type of hospitalization:

Indications for emergency hospitalization:
· Burns of eyes and its appendages of moderate and more severity.
Indications for planned hospitalization: No

Information

Sources and Literature

Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
1. List of used literature (valid research links to the listed sources are required in the text of the protocol): 1) Eye diseases: textbook / Under. ed. V.G. Kopaeva. - M .: Medicine, 2002 .-- 560 p. 2) Dzhaliashvili O.A., Gorban A.I. First aid for acute diseases and eye injuries. - 2nd ed., Revised. and add. - SPb .: Hippocrates, 1999 .-- 368 p. 3) Puchkovskaya N.A., Yakimenko S.A., Nepomnyashchaya V.M. Eye burns. - M .: Medicine, 2001 .-- 272 p. 4) Ophthalmology: national guidelines / Ed. C.E. Avetisova, E.A. Egorova, L.K. Moshetova, V.V. Neroeva, H.P. Takhchidi. - M .: GEOTAR-Media, 2008 .-- 944 p. 5) Egorov E.A., Alekseev V.N., Astakhov Y.S., Brzhesky V.V., Brovkina A.F., et al. Rational pharmacotherapy in ophthalmologists: a guide for practicing physicians / Ed. ed. E.A. Egorova. - M .: Litterra, 2004 .-- 954 p. 6) Atkov O.Yu., Leonova E.S. Patient management plans "Ophthalmology" Evidence-based medicine, GEOTAR - Media, Moscow, 2011, pp. 83-99. 7) Guideline: Work Loss Data Institute. Eye. Encinitas (CA): Work Loss Data Institute; 2010. Various p. 8) Egorova E.V. et al. Technology of surgical interventions for extensive post-traumatic defects and deformities in the eyelid region \\ Mater. 111 Euro-Asian Conf. on ophthalmosurgery. - 2003, Yekaterinburg. - with. 33

Information

List of protocol developers with qualification data:

1) Isergepova Botagoz Iskakovna - Candidate of Medical Sciences, Head of the Department of Management of Scientific and Innovative Research of JSC Kazakh Research Institute of Eye Diseases.
2) Makhambetov Dastan Zhakenovich - ophthalmologist of the 1st category, JSC Kazakh Research Institute of Eye Diseases.
3) Mukhamedzhanova Gulnara Kenesovna - Ph.D. S. Asfendiyarova ".
4) Zhusupova Gulnara Darigerovna - candidate of medical sciences, associate professor of the department of JSC "Astana Medical University".

No Conflict of Interest Statement: No

Reviewer: Shusterov Yuri Arkadievich - Doctor of Medical Sciences, Professor, RSE at the REM "Karaganda State Medical University", Head of the Department of Ophthalmology.

Indication of the conditions for revision of the protocol:
Revision of the protocol 3 years after its publication and from the date of its entry into force or if there are new methods with a level of evidence.

Attached files

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A chemical burn to the organs of vision occurs due to contact with aggressive chemical reagents. They lead to damage to the anterior part of the eyeball, cause unpleasant symptoms: pain, irritation and can lead to vision problems.

The main signs

An eye burn is not a disease, but a pathological condition that can be completely eliminated if you turn to an ophthalmologist in time.

List of symptoms:

Sharp pain in the eyes. But why there is pain in the eyeball when pressed, this will help to understand
Redness of the conjunctiva.
Discomfort, burning sensation, irritation.
Increased lacrimation.

It is difficult not to notice chemical damage to the organ of vision. It's all about the pronounced symptoms, which are gradually increasing.

Substances of a chemical nature act gradually. Once on the skin of the eyes, they cause irritation, but if the burn is left unattended, then its manifestations will only intensify.

Aggressive reagents gradually damage the skin of the eyelids and eyes. It is possible to assess the degree of the inflicted "injuries" and their severity in 2-3 days. But what are the diseases of the eyelids of the eyes in humans and which drops should be used, indicated in this

Burn classification

The video shows a description of a chemical eye burn:

Clinical manifestations

Damage to the surface of the skin of the eyelids.
The presence of foreign substances in the tissues of the conjunctiva. But what can be the symptoms of conjunctivitis of the eyes in children, you can see
Increased intraocular pressure (ocular hypertension).

Abundant damage to the skin occurs upon contact with reagents. The substances irritate the mucous membranes, which leads to redness and irritation of the anterior parts of the eyeball.

During an ophthalmological examination, particles of foreign substances are found, they are clearly visible during a clinical examination. Research helps to establish which substance led to the development of damage (acid, alkali).

Reagents act on the parts of the eyeball in a special way. Contact leads to "drying" or drying out of the mucous surface and an increase in the level of intraocular pressure. But what are the symptoms of increased eye pressure in adults, is described in great detail in this

Assessment of the totality of symptoms helps to make the correct diagnosis for the patient. The ophthalmologist determines the degree of the burn, conducts diagnostic procedures and selects adequate treatment.

ICD-10 code

T26.5- a burn of a chemical nature and the area around the eyelid;
T26.6- a chemical burn with reagents with damage to the cornea and conjunctival sac;
T26.7- severe chemical burns with tissue damage leading to rupture of the eyeball;
T26.8- a chemical burn that has affected other parts of the eye;
T26.9-burn of a chemical nature, affecting the deep parts of the eyeball.

First aid

In case of damage to the tissues of the eyeball, tissues of the eyelids and conjunctiva, the patient needs first aid.

So, the principles of its provision:

Do not wash your eyes with running water, use cosmetic creams. This can lead to increased signs of chemical attack.

Once on the skin, the cream creates a protective shell from above, as a result of which the effect of aggressive reagents is enhanced. For this reason, do not apply cream or other cosmetic products to the skin.

What drugs can you use:

A solution of potassium permanganate should be weak, it will help neutralize the effect of aggressive substances. You can dilute potassium permanganate, prepare furacilin, or simply rinse the organs of vision with warm, slightly salted water.

Rinse your eyes as often as possible, every 20-30 minutes. If the symptoms are pronounced, then you can take pain relievers: Ibuprofen, Analgin or any other pain relieving medications.

Treatment

It is advisable to consult a doctor when the first signs of a chemical burn appear. The doctor will select adequate therapy and help reduce unacceptable symptoms.

Most often, the following drugs are prescribed for treatment:

Antiseptics are part of combination therapy, they stop the inflammatory process and promote the restoration of soft tissues, relieve swelling and redness.

Antibacterial drugs are prescribed to relieve the inflammatory process. They contribute to the death of pathogenic microflora and accelerate the process of cell regeneration.

Anti-inflammatory drugs can also include glucocorticosteroids, they enhance the effect of antibacterial drugs and antiseptics. With regular use, they reduce the intensity of unpleasant symptoms.

Local pain relievers are used in the form of drops. They help to reduce the severity of the pain syndrome.

If there is an increase in the level of intraocular pressure (most often diagnosed upon contact with alkalis), then medications are used that reduce the signs of intraocular hypertension.

Medicines based on human tears. They help to soften the irritated conjunctiva and reduce the signs of the inflammatory process, remove edema and partially the hyperthermia of the lining of the eyelid.

List of drugs prescribed for eye burns:

Group of drugs:	Name:
Glucocorticosteroids:	Prednisolone, Hydrocortisone in the form of an ointment.
Antibiotics:	Tetracycline, Erythromycin ointment
Antiseptics:	Sodium Chloride, Potassium Permanganate.
Anesthetics:	Dicaine solution.
Preparations based on human tears:	Visoptic, Vizin.
Drugs that reduce the manifestations of intraocular hypertension:	Acetazolamide, Timolol.
Medicines that accelerate the regenerative processes in cells:	Solcoseryl, Taurine.

Solcoseryl is available in the form of an ointment, the drug significantly speeds up the healing process and helps to avoid pronounced scarring of the tissue. And taurine as a substance "inhibits" the development of irreversible changes in the parts of the eyeball. , like other medicines, describes in detail the dosage and frequency of use. Carefully follow the rules for the use of any drugs!

Ophthalmologists prefer this substance to Timolol when signs of high intraocular pressure appear.

What to do if there was a chemical burn of the eye after eyelash extension?

Getting burned with eyelash extensions occurs for several reasons. This can be exposure to heat - damage of a thermal nature or chemistry (contact with the skin of the eyelids or mucous glue).

If you have problems with eyelash extension, you should carry out the following procedures:

rinse your eyes with a solution of potassium permanganate. But the information on the link will help to understand.
drip Taurine or any other drops into the eyeballs to reduce the inflammatory process (drugs based on human tears can be used);
see a doctor for help.

If the damage is of a local nature, then an appeal to an ophthalmologist is necessary. Since only a doctor will be able to assess the severity of the situation and provide the patient with adequate assistance.

On the video - eye burn after eyelash extension:

If glue gets on the skin, then there is a likelihood of developing blepharitis and other inflammatory diseases. To prevent this from happening, it is necessary to take appropriate measures and consult an ophthalmologist as soon as possible. But how to use it correctly and what their price is, you can see in this article.

You will also need to remove extended eyelashes, since the glue irritates the skin of the eyelids and leads to an increase in unpleasant symptoms.

A chemical burn to the organs of vision is a serious injury that requires immediate treatment. First aid can be provided to yourself on your own, but subsequent treatment should preferably be under the supervision of a doctor.

15-10-2012, 06:52

Description

SYNONYMS

Chemical, thermal, radiation damage to the eyes.

ICD-10 code

T26.0... Thermal burn of the eyelid and periorbital region.

T26.1... Thermal burns of the cornea and conjunctival sac.

T26.2. Thermal burn, leading to rupture and destruction of the eyeball.

T26.3. Thermal burns to other parts of the eye and its adnexa.

T26.4... Thermal burns of the eye and its accessory apparatus of unspecified localization.

T26.5... Chemical burns of the eyelid and periorbital region.

T26.6. Chemical burns of the cornea and conjunctival sac.

T26.7. Chemical burn, leading to rupture and destruction of the eyeball.

T26.8. Chemical burns to other parts of the eye and its adnexa.

T26.9. Chemical burns of the eye and its accessory apparatus of unspecified localization.

T90.4. Consequence of trauma to the eye of the periorbital region.

CLASSIFICATION

I degree- hyperemia of various parts of the conjunctiva and the limbus zone, superficial corneal erosion, as well as hyperemia of the eyelid skin and their swelling, slight swelling.
II degree b - ischemia and superficial necrosis of the conjunctiva with the formation of easily removable whitish scabs, opacity of the cornea due to damage to the epithelium and surface layers of the stroma, the formation of blisters on the skin of the eyelids.
III degree- necrosis of the conjunctiva and cornea to deep layers, but not more than half of the surface area of the eyeball. Corneal color - "matte" or "porcelain". Changes in ophthalmotonus are noted in the form of a short-term increase in IOP or hypotension. Possible development of toxic cataract and iridocyclitis.
IV degree- deep lesion, necrosis of all layers of the eyelids (up to charring). Damage and necrosis of the conjunctiva and sclera with vascular ischemia on the surface of more than half of the eyeball. The cornea is "porcelain", a tissue defect in excess of 1/3 of the surface area is possible, in some cases perforation is possible. Secondary glaucoma and severe vascular disorders - anterior and posterior uveitis.

ETIOLOGY

Conventionally, chemical (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and radiation burns are distinguished.

CLINICAL PICTURE

Common signs of eye burns:

the progressive nature of the burn process after the cessation of exposure to the damaging agent (due to metabolic disturbances in the tissues of the eye, the formation of toxic products and the emergence of an immunological conflict due to autointoxication and autosensitization to the post-burn period);
a tendency to recurrence of the inflammatory process in the choroid at various times after receiving a burn;
a tendency to the formation of synechiae, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.

Stages of the burn process:

Stage I (up to 2 days) - the rapid development of necrobiosis of the affected tissues, excessive hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acidic polysaccharides;
Stage II (2-18 days) - manifestation of severe trophic disorders due to fibrinoid swelling:
Stage III (up to 2-3 months) - trophic disorders and vascularization of the cornea due to tissue hypoxia;
Stage IV (from several months to several years) - a period of scarring, an increase in the amount of collagen proteins due to the enhancement of their synthesis by corneal cells.

DIAGNOSTICS

Diagnosis is by history and clinical presentation.

TREATMENT

Basic principles of treating eye burns:

provision of emergency care aimed at reducing the damaging effect of the burn agent on tissue;
subsequent conservative and (if necessary) surgical treatment.

When providing emergency assistance to the victim, it is imperative to intensively rinse the conjunctival cavity with water for 10-15 minutes with mandatory eversion of the eyelids and rinsing of the lacrimal passages, thorough removal of foreign particles.

Washing is not carried out with a thermochemical burn, if a penetrating wound is found!

Surgical interventions on the eyelids and eyeball in the early stages are carried out only with the aim of preserving the organ. Vitrectomy of burnt tissues, early primary (in the first hours and days) or delayed (after 2-3 weeks) blepharoplasty with a free skin flap or a skin flap on a vascular pedicle with a one-step auto mucous membrane transplant on the inner surface of the eyelids, arches and on the sclera is performed.

Planned surgical interventions on the eyelids and the eyeball with the consequences of thermal burns are recommended to be carried out 12-24 months after the burn injury, since against the background of autosensitization of the body, allosensitization to the graft tissues occurs.

For severe burns, it is necessary to inject 1500-3000 IU of anti-tetanus serum subcutaneously.

Treatment of stage I eye burns

Long-term irrigation of the conjunctival cavity (within 15-30 minutes).

Chemical neutralizers are used in the first hours after a burn. Subsequently, the use of these drugs is impractical and can have a damaging effect on burnt tissue. The following agents are used for chemical neutralization:

alkali - 2% boric acid solution, or 5% citric acid solution, or 0.1% lactic acid solution, or 0.01% acetic acid:
acid - 2% sodium bicarbonate solution.

With severe symptoms of intoxication, Belvidon is prescribed intravenously 1 time per day, 200-400 ml per night drip (up to 8 days after injury), or 5% dextrose solution with ascorbic acid 2.0 g in a volume of 200-400 ml, or 4- 10% dextran solution [cf. pier weight 30 000-40 000], 400 ml intravenous drip.

NSAIDs

H1 receptor blockers: chloropyramine (25 mg orally 3 times a day after meals for 7-10 days), or loratadine (10 mg orally 1 time per day after meals for 7-10 days), or fexofenadine (inside 120-180 mg 1 time per day after meals for 7-10 days).

Antioxidants: methylethylpyridinol (1% solution, 1 ml intramuscularly or 0.5 ml parabulbar once a day, for a course of 10-15 injections).

Analgesics: metamizole sodium (50%, 1-2 ml intramuscularly for pain) or ketorolac (1 ml for pain intramuscularly).

Preparations for instillation into the conjunctival cavity

In severe conditions and in the early postoperative period, the frequency of instillations can reach 6 times a day. As the inflammatory process decreases, the duration between instillations increases.

Antibacterial agents: ciprofloxacin (0.3% eye drops, 1-2 drops 3-6 times a day), or ofloxacin (0.3% eye drops, 1-2 drops 3-6 times a day), or 0.3% tobramycin ( eye drops, 1-2 drops 3-6 times a day).

Antiseptics: picloxidine 0.05% 1 drop 2-6 times a day.

Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone (eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisolone (eye drops 0.5% 1-2 drops 3-6 times a day).

NSAIDs: diclofenac (inside 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (inside 25 mg 2-3 times a day after meals, course 10-14 days).

Midriatic: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day) in combination with phenylephrine (eye drops 2 , 5% 2-3 times a day for 7-10 days).

Corneal regeneration stimulants: actovegin (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or solcoseryl (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or dexpanthenol (eye gel 5% for the lower eyelid 1 drop 2-3 times a day).

Surgery: sectoral conjunctivotomy, corneal paracentesis, necrectomy of the conjunctiva and cornea, genonoplasty, corneal biocoating, eyelid surgery, lamellar keratoplasty.

Treatment of stage II eye burns

The treatment is supplemented with groups of drugs that stimulate immune processes, improve the utilization of oxygen by the body and reduce tissue hypoxia.

Fibrinolysis inhibitors: aprotinin, 10 ml intravenously, for a course of 25 injections; instillation of the solution into the eye 3-4 times a day.

Immunomodulators: levamisole 150 mg once a day for 3 days (2-3 courses with a break of 7 days).

Enzyme preparations: systemic enzymes 5 tablets 3 times a day 30 minutes before meals, drinking 150-200 ml of water, the course of treatment is 2-3 weeks.

Antioxidants: methylethylpyridinol (1% solution, 0.5 ml parabulbar once a day, for a course of 10-15 injections) or vitamin E (5% oily solution, 100 mg orally, 20-40 days).

Surgery: layer-by-layer or penetrating keratoplasty.

Treatment of stage III eye burns

The following are added to the above treatment.

Short-acting mydriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day).

Antihypertensive drugs: betaxolol (0.5% eye drops, 2 times a day), or timolol (0.5% eye drops, 2 times a day), or dorzolamide (2% eye drops, 2 times a day).

Surgery: keratoplasty for emergency indications, antiglaucomatous operations.

Treatment of stage IV eye burns

The following are added to the treatment.

Glucocorticoids: dexamethasone (parabulbarly or under the conjunctiva, 2-4 mg, for a course of 7-10 injections) or betamethasone (2 mg betamethasone disodium phosphate + 5 mg betamethasone dipropionate) parabulbarly or under the conjunctiva 1 time per week 3-4 injections. Triamcinolone 20 mg once a week 3-4 injections.

Enzyme preparations in the form of injections:

fibrinolysin [human] (400 U parabulbar):
collagenase 100 or 500 KU (the contents of the vial are dissolved in 0.5% procaine solution, 0.9% sodium chloride solution or water for injection). It is administered subconjunctivally (directly into the lesion focus: adhesion, scar, CT, etc. using electrophoresis, phonophoresis, and also applied to the skin. in the absence of an allergic reaction, treatment is carried out within 10 days.

Drug-free treatment

Physiotherapy, massage of the eyelids.

Approximate terms of incapacity for work

Depending on the severity of the lesion, it is 14-28 days. Disability is possible in the event of complications, loss of vision.

Further management

Observation by an ophthalmologist at the place of residence for several months (up to 1 year). Control of ophthalmotonus, ST condition, retina. With a persistent increase in IOP and the absence of compensation in the drug regimen, antiglaucomatous surgery is possible. With the development of traumatic cataract, removal of the cloudy lens is indicated.

FORECAST

Depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the victim's admission to the hospital, the correctness of the appointment of drug therapy.

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