Ver el código de «Caustic keratoconjunctivitis»

==Background==
*Chemical burn to eye
*Alkali injuries are more severe than acidic injuries, and are considered an '''ophthalmologic emergency'''
*Prognosis is determined by the extent of injury at the limbus and area/depth of injury to cornea

{{Caustics background}}

{{Keratoconjunctivitis Types}}

==Clinical Features==
[[File:Chemical burn injury..jpg|thumb|Complication of an alkali corneal burn causing ocular surface failure with neovascularisation, opacificatio,n and blindness.]]
*Severe [[eye pain|ocular pain]], blepharospasm, reduced [[vision loss|visual acuity]]
*Altered ocular pH (normal = 7.0-7.2)
*Appearance
**[[red eye|Conjunctival injection]] '''OR''' blnnching
**Chemosis, hemorrhage, epithelial defects
**Corneal loss '''OR''' edema
*Perilimbal ischemia (white ring around iris)
**Concerning due to co-location of corneal stem cell layer (re-epitheliazation relies on migration of limbal stem cells)
===[[Caustic burns|Alkali Burns]]===
*Rapid penetration through cornea and anterior chamber
*Causes liquefaction necrosis from hydroxyl ions combining with fatty acids
*Elevated [[IOP]] may be seen in alkali injury<ref>Lin, M.P., et al., Glaucoma in patients with ocular chemical burns. American journal of ophthalmology, 2012. 154(3): p. 481-485 e1.</ref>
*Acute injury liquefaction necrosis and ischemia which can be graded on degree of limbal and corneal involvement
*Early sequelae corneal edema and elevated IOP
*Later injury after one week - corneal breakdown, [[corneal ulcer|ulceration]], perforation because of collagenase activity exceeds synthesis

===[[Caustic burns|Acid Exposure]]===
*Injury related to length of exposure and concentration of chemical
*Causes coagulation necrosis and protein precipitation thus limits depth of penetration
*Delayed complications corneal and conjunctival scarring, vascularization, [[glaucoma]], [[uveitis]]

===Other Chemicals===
*Most exposures produce only simple irritation

===Roper-Hall classification<ref>Gupta N et al. Comparison of Prognostic Value of Roper Hall and Dua Classification Systems in Acute Ocular Burns. Br J Ophthalmol. 2011;95(2):194-198. http://www.medscape.com/viewarticle/739100.</ref>===
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Grade'''
| align="center" style="background:#f0f0f0;"|'''Cornea Appearance'''
| align="center" style="background:#f0f0f0;"|'''Limbal Ischemia'''
| align="center" style="background:#f0f0f0;"|'''Prognosis'''
|-
| I||Clear||None||Good
|-
| II||Hazy/iris details visible||<1/3||Good
|-
| III||Opaque/iris details obscured||1/3-1/2||Guarded
|-
| IV||Opaque/iris details obscured||>1/2||Poor
|-
|}

==Differential Diagnosis==
{{Caustic burn types}}

{{Conjunctivitis DDX}}

{{Unilateral red eye DDX}}

==Evaluation==
*Generally a clinical diagnosis

==Management==
{{Caustic ocular exposure managment}}

==Disposition==
===Admit===
*Pediatric patient
*Corneal haziness, opacity, or limbal ischemia (paleness at limbus)

===Discharge===
''With 24hr ophthalmology follow-up''
*If only has corneal epithelial injury
**Encourage use of artificial tears and other lubricating eyedrops

==See Also==
*[[Eye Algorithms (Main)]]
*[[Caustic burns]]
*[[Keratoconjunctivitis]]

==References==
<references/>

[[Category:Ophthalmology]]
[[Category:Trauma]]
[[Category:Toxicology]]