Transcript Surveillance of Severe Chemical Corneal Injuries in the UK

BOSU
Surveillance of Severe
Chemical Corneal Injuries
in the UK
Elisabeth CA Macdonald, Paul A Cauchi,
Augusto Azuara-Blanco, Barny Foot
Authors have no financial interest
Background
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Chemical injuries to the eye represent one of the true
emergencies in ophthalmology
They may require extended medical care and result in
longterm ocular morbidity
Public health and occupational health strategies have
attempted to reduce the rate of these
The true incidence of these in the UK and subsequent
demand on medical services was unknown
This study aimed to estimate the national incidence of
severe chemical corneal injuries in the UK
BOSU
Method
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Prospective population based study
Performed with British Ophthalmological
Surveillance Unit (BOSU) monthly reporting
system
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Run by the RCOphth, UK
Method
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Monthly report card with case definition sent to all
consultant or associate specialist ophthalmologists
with clinical autonomy in the UK
Respondents indicate how many cases they have
seen that month
Investigators are notified of positive reports
Reporting ophthalmologist is contacted using a
questionnaire to collect information regarding case
Method
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12 month study period Dec 2005- Nov 2006
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Report of any severe chemical corneal injury
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Def.- an injury with all of the following:
1. Total loss of the corneal epithelium
2. Corneal haziness obscuring iris detail or worse
3. Over 120o of limbal ischaemia
 Grade 3 or 4 on the Hughes-Roper-Hall scale
Results
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Monthly card return rate 78%
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Twelve cases were identified
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Min. estimated incidence in the UK of severe
chemical corneal injury of 0.02 per 100 000
66.7% of injuries were in males of working age
(16-65yrs)
Min. estimated incidence in the UK of severe
chemical corneal injury in males of working
age of 0.04 per 100 000
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Results
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75% occurred in males
Mean age at time of injury was 33.8 yrs
 Range 10–59 yrs
50% occurred at work
33.3% resulted from assault
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Results
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Alkali was causative in 66.7%
Only one patient was wearing eye protection
at the time of injury
75% received immediate irrigation
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Results
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Six patients required 1 or more surgical
procedures
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Amniotic membrane graft was the most
common surgical procedure
At 6 months follow-up BCVA
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6/12 or better in 5 patients
6/60 or worse in 2 patients
BOSU
Conclusion
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The incidence of severe chemical corneal injury
in the UK is low
The cases that occur can require extended
hospital treatment, with substantial ocular
morbidity and visual sequelae
Current enforcement of eye protection in the
workplace in the UK has probably contributed
to a reduced incidence of severe ocular burns