Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
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Chemical burns of the eye are becoming rare due to improvements in occupational protection. Effective decontamination is the foundation for good clinical results of this ophthalmological emergency. The toxicological aspect focuses on classifying the specific toxicity of a chemical substance by evaluating the degree of eye irritation and eye burns. ⋯ In an integral approach it is shown that substance-specific characteristics, such as concentration and specific reactivity as well as individual features, such as mode and duration of exposition have an influence on the clinical appearance of the tissue damage. The decontamination is dependent on the mode of action and the effectiveness of the decontamination solution. Amphoteric substances have the best effectiveness for decontamination of the eye due to their specific characteristics.
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The basic principles of first aid for chemical and thermal burns are discussed. In the acute phase the primary goal of all measurements is the prevention or limitation of tissue destruction. ⋯ In the case of severe and very severe ocular burns a comprehensive surgical reconstruction is included. All outpatient departments and eye clinics taking part on the treatment have to ensure a standardized complete and scientifically valid therapy regime to restore vision.
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With these recommendations the authors want to improve the acute therapy of eye burns based on the literature and clinical experience. Due to the lack of studies with high evidential value we base these recommendations on the results of experimental work and reports of successfully treated eye burns. A development of this document by systematic research is necessary. ⋯ Within experimental work in vitro we could show the value of polyvalent decontamination. Side-effects of phosphate buffers have been demonstrated in retrospective clinical and prospective experimental studies so that even in cases of beneficial effects on pH we cannot recommend these substances which propagate corneal calcification. Special types of burns, such as hydrofluoric acid need special treatment but as clinical studies are lacking only experimental data can offer suitable recommendations.