2003/08/01
precipitation & coag limits depth of penetration in acid
alkaline causes saponification, deep penetration into deep membranes
grading of burn severity:
- epithelial integrity
- stromal clarity
- limbal ischemia (most important!)
4 phases:
immediate
acute 1-7
early repair 7-21
late repair >21 d
tx:
• copious irrigation
• recheck pH
and remove any remaining particles or debris
• control
inflammation with steroid
• prevent
infection, prevent persistent epitheliopathy, prevent sterile ulceration, prevent IOP spikes
topical corticosteroids
• encourages
re-epithelialization
• promotes
early stromal repair
- use s
hesitation for first 10 days
- p 10-14
days, can interfere with stromal wound repair by impairing keratocyte migration
and collagen synthesis
- may be
able to substitute NSAIDs or medroxyprogesterone p 10 days
• sodium ascorbate (topical and oral)
- necessary for collagen synthesis
- 10% sol
topically q2o
- 2 g
orally/day
• na citrate (topically)
- calcium chelator
- impairs
PMN chemotaxis, phagocytosis, and release of lysosomal enzymes
- 10%
solution topically q2o
• tetracycline - reduces collagenase activity and inhib PMN
activity
• control
IOP c beta-blocker or diamox
spec tx:
topic corticosteroids qid-q h
vit c topically q2o 10%
tetracycline ointment qid
vit c po 2g/d
doxy 100mg po bid
try to get off of all unnecessary drops c preservatives