How is ocular surface (epithelial) healing promoted following chemical burns to the eye?

Updated: Oct 08, 2019
  • Author: Mark Ventocilla, OD, FAAO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Once the inciting chemical has been completely removed, epithelial healing can begin. Chemically injured eyes have a tendency to poorly produce adequate tears; therefore, artificial tear supplements play an important role in healing. Topical antibiotic ointment should be applied frequently to help the surface heal and to prevent secondary infection. Topical steroids are also needed to control inflammation, which facilitates epithelial healing.

Ascorbate plays a fundamental role in collagen remodeling, leading to an improvement in corneal healing. It may also prevent or delay corneal ulceration. It is available in topical and oral forms. Oral tetracycline class antibiotics (tetracycline, minocycline, doxycycline) may also decrease the risk of corneal melting through inhibition of matrix metalloproteinases.

Placement of a therapeutic bandage contact lens until the epithelium has regenerated can be helpful in some patients. [11]

Amniotic membrane transplant in eyes with acute ocular burns promotes faster healing of epithelial defects in patients with moderate grade burns. [12] Amniotic membranes have anti-inflammatory, antimicrobial, anticollagenolytic, and growth factor properties that can enhance epithelial rejuvenation. The Prokera (Bio-Tissue) brand device is a sutureless office-based amniotic membrane that has been proven to be extremely useful in acute moderate chemical injuries.

No long-term advantage of amniotic membrane transplant is evident when compared with medical and mechanical release of adhesions in terms of final visual outcome, appearance of symblepharon, and corneal vascularization in a controlled clinical setting. [12]


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