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Chemical burns of the ocular surface (CBOS) are emergencies of highest urgency. Therefore, an adequate emergency care is mandatory. Following a precise analysis of the initial damage, a staged therapeutic approach is used to prevent persistent impairment of the ocular surface. In the acute stage, the prevention of complications is targeted (symblepharon, conjunctival scarring, lacrimal stenosis, corneal ulceration, intraocular inflammation, elevated intraocular pressure, etc.). In later stages, if complications have developed, a secondary restoration of the ocular surface is focussed. Sometimes this requires several surgical interventions. Based on a review of international literature, this review highlights the pathophysiology according to different chemical agents, CBOS stages as well as main therapy strategies in early and advanced stages of CBOS. Acute treatment aims to lower inflammation, oxidative stress and tries to promote reepithelialisation. Besides conjunctival scarring, loss of goblet cells and corneal opacification a limbal stem cell insufficiency is the most harming complication. Several new techniques have been developed to recover the ocular surface with a sufficient and clear epithelial layer in order to avoid neovascularization of the cornea. The knowledge concerning the high risk potential for persistent visual impairment in CBOS patients and the ability for appropriate emergency care should be kept in every physician's mind dealing with CBOS., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein. Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: This review gives a therapeutic approach for the early treatment of chemical and thermal burns of the ocular surface (CTOS). Method: Based on a review of international literature, the experiences of University Hospital Aachen and Halle/Saale, Eye Clinic Cologne as well as experimental data of the research institute (An-Institut) at RWTH Aachen University are considered and discussed. Results: As the risk depends on the stage of CTOS, recommendations are given for acute treatment for different stages. Pathophysiological considerations will be discussed. Special treatment options for exceptional situations and for late phase CTOS are demonstrated. Conclusion: According to the latest data, the most important clinical recommendation for the acute phase of CTOS is the application of a suitable rinsing solution. Furthermore, anti-inflammatory treatment is of central importance. For the therapy of severe CTOS, approved and advanced surgical methods need to be applied. In this way, anti-inflammatory and tissue-protecting mechanisms are activated simultaneously., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Four eyes of two patients were injured simultaneously by industrial alkali while working. One eye of both patients healed without later consequences., Patients and Methods: Two eyes were treated with phototherapeutic keratectomy (PTK) because of recurrent corneal erosion syndrome caused by alkali burn., Results: In both cases reepithelisation of the cornea was completed by the end of the 1st postoperative week, the injured persons were able to work again. No recurrence was experienced in the next 6 months of follow-up., Conclusion: With these cases the authors would like to draw attention to the possible complications, as well as the importance of careful balancing and adequate management., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Severe alkali burns lead to massive limbal stem cell damage resulting in persistent epithelial defects, infiltration and stromal melting early in the disease process. A glued-on hard contact lens may serve as an "artificial epithelium" and protect the cornea from these complications., Case Report: A 39-year-old male presented with severe lime burns in both eyes one week after injury. The right eye showed a totally denuded cornea and conjunctiva with circular paralimbic ischemia. In the left eye "only" two thirds of the cornea and adjacent conjunctiva and limbus were affected with less ischemia. Amniotic membrane transplantation was performed in both eyes but failed after four days already in the right eye. A hard contact lens was therefore glued on the right eye and allowed for visual acuity of 0.4 without correction in this primarily most heavily afflicted eye for 12 months duration. After removal of the contact lens, reepithelisation was quick, and function remained stable with addition of autologous serum eye drops. The primarily far less injured left eye, however, for which the amniotic membrane surgery was primarily judged to be adequate, could not be stabilised. The cornea perforated 4 weeks later necessitating a mini-keratoplasty plus a glued-on contact lens, and correctable vision never became better than 1/35., Conclusion: The clinical course confirms former observations that a glued-on hard contact lens is an effective treatment early after alkali burn and prevents the cornea from infiltration and melting. Moreover, two aspects merit consideration: first, with proper technique and timing of the gluing-on a patient may retain useful vision throughout the period of wearing the contact lens; second, for the long period during which the cornea was sealed by the contact lens, improper repopulation by conjunctival epithelium was inhibited, and proper corneal epithelium was given a chance for repopulation after recovery of the limbal area resulting in a stable surface and useful vision without additional keratoplasty measures.

Background: Eye rinsing is the major therapeutic measure with a decisive impact on prognosis after chemical or thermal eye irritation. Several different major targets are addressed by this measure., Aim of the Study: Up to now emphasis in research was placed mostly on the neutralisation of chemical products. Newer experimental results on the basis of biological experiments interpreted against the background of basic chemical reactions may enhance clinical treatment by introducing new mechanisms of intervention., Materials and Methods: Experiments on the modification of osmolarity, buffering capacity and solubility products show new possibilities of therapy in eye rinsing after eye irritation. These mechanisms are demonstrated by means of key experiments., Results: The official recommendation of rinsing a burnt eye with water seems to be insufficient against the background of actual experimental data. Measurements of pH after eye burns indicate no buffering effects for water, or aqueous saline solution. There was weak buffering for phosphate buffer in alkali burns and a high capacity for neutralisation for diphoterine in alkali and acid burns. Ionic contents and osmolarities of the rinsing solutions have a decisive influence on the ionic composition and osmolarity of the burnt cornea after rinsing. Cellular damage is enhanced in unaffected healthy cell cultures by hyposomolar rinsing., Conclusion: We recommend buffered solutions with high buffer capacities for initial eye rinsing. The advantage or disadvantage of the elevated concentration of ions in the buffered rinsing solutions determining osmolarity cannot be confirmed or refuted up to now. It seems to us to be certain that osmolarity is a decisive future factor in initial rinsing.

Background: Until now there were no statistical data on the incidence and the prevalence of eye burns. Therefore we studied all patients coming to our hospital from the area of Aachen with eye burns during the time from September 1990 until August 1991., Patients and Methods: All patients underwent a standardized examination including special history of the burning agent, industrial medical aspects and the employers liability insurance association. The documentation of the anterior eye segment pathology was scored separately for each eye encoded by location and special items. This documentation was worked up by the aid of a database (Filemaker II). 171 patients with eye burns were documented during one year. 65 patients had both eyes burned resulting in 236 documented records., Results: The 171 accidents can be divided in 104 (61%) industrial accidents and 64 (37%) housework accidents. 3 accidents were of unknown origin. Classification of burns was scored according to Reim 1991. 208 (88%) eyes showed score I burns, 27 (11.5%) score II and only one patient showed a score III eye burn. We saw 121 (70%) male patients, 39 (23%) female patients and 11 children (7%). The main age group ranged from 16-45 years. 28% (n = 30) of all accidents happened in machine factories, which have thereby in our study the highest incidence of industrial accidents., Conclusion: By means of a one-year statistic we found that over 60% of all eye burns were industrial accidents, 28 in machine factories and 20% in service industries. 37% houseworks accidents are very difficult to prevent because of a deficit of safety rules.

Background: Persistent epithelial defects of the cornea are difficult to treat and can lead to severe complications such as melting processes. Therefore the application of a glued-on hard contact lens as an artificial epithelium has been recommended for many years, to protect the denuded corneal stroma., Materials and Methods: This paper presents a 7-year retrospective study on the application of a hard contact lens as an artificial epithelium. 46 patients with 50 eyes were treated with this method from january 1985 to march 1992. The majority of the patients suffered from most severe burns of the whole anterior eye segment (group I: n = 29 eyes) or of the cornea alone (group II: n = 13 eyes). A smaller number of patients (group III: n = 8 eyes) presented corneal melting processes associated with other diseases., Results: The patients of group II and III showed the best outcome concerning spontaneous epithelialization and prognosis for a penetrating keratoplasty. The treatment with a glued-on hard contact lens was limited by the high rate of complications (92%) in group I and II. In one third of the cases of group I these complications led to further surgical interventions (e.g. conjunctivoplasty of the globe). The results also show, that the application of a glued-on hard contact lens in patients with most severe eye burns is a long-term treatment (> one year)., Conclusion: The poor prognosis of corneas with severe healing problems of the epithelium can be improved by the application of a glued-on hard contact lens as an artificial epithelium. In severe burns of the whole anterior eye segment however, the treatment with an early keratoplasty should be considered.

BN 52 021, a specific antagonist of PAF receptors, was tested in the early-phase treatment of chemically burned eyes in 30 rabbits. The local application of BN 52 021 eyedrops-1% (water-soluble preparation, 5 times daily, in comparison with the other eye as a control) led to a visible anti-inflammatory effect (microscopically and macroscopically) of the chemically burned anterior eye segment. There was only a moderate increase of the concentration of PGF2 alpha after the chemical burn. The use of specific PAF antagonists seems to have a real chance for treatment of inflammatory reactions of the anterior eye segment. A combination with other mediator antagonists should be tested in further experiments.

Experimental and clinical observations suggested that after alkali burns of the eyes, neutralization of the tissues and the aqueous humor occurred with in hours. The further course of the disease was found to be an inflammatory reaction. Consequently, an anti-inflammatory therapy was introduced and employed with success in experiments and in the clinics.

This paper reports on 6 cases of keratoconjunctivitis caused by the latex of Euphorbiaceae, one of them with slight systemic intoxication. Phorbolesters are considered to be responsible for the toxicity of the latex of Euphorbiaceae, e.g., in the case of Euphorbia helioscopia, 12-Desoxyphorbol-13-phenylacetate-2-O-acetate. Since all of the cases of keratoconjunctivitis Euphorbiae described here, as well as the majority of those cited in the literature, have resulted in a restitutio ad integrum, a benign course may be expected, even in cases of keratoconjunctivitis Euphorbiae with initially severe clinical pictures.