Regarding the management of chemical injuries to the eye, all of the following are true EXCEPT:

Explanation

## Chemical Eye Injuries: Management Principles ### Immediate Management Priority **Key Point:** Immediate and copious irrigation is the cornerstone of chemical eye injury management. This must be done within seconds to minutes of exposure — delay significantly worsens prognosis. ### Alkali vs. Acid Burns: Pathophysiology | Feature | Alkali Burns | Acid Burns | |---------|--------------|------------| | Mechanism | Liquefactive necrosis (saponification of lipids) | Coagulative necrosis (protein precipitation) | | Penetration | Deep, progressive; damages stromal collagen | Superficial; coagulum acts as barrier | | Severity | Generally more severe | Generally less severe | | Prognosis | Worse; ongoing damage for days | Better; damage limited | **High-Yield:** Alkali burns are more destructive because they continue to penetrate and cause tissue damage even after the initial insult, whereas acid burns are self-limiting due to the protective coagulum. ### Post-Irrigation Management **Key Point:** After irrigation: 1. Instill topical antibiotics (to prevent secondary infection) 2. Instill cycloplegics (atropine) to reduce pain and prevent posterior synechiae 3. Remove particulate matter (lime particles in alkali burns) 4. Assess for anterior chamber involvement ### Role of Systemic Corticosteroids **Clinical Pearl:** Systemic corticosteroids are NOT contraindicated in chemical injuries. In fact, they are often beneficial in moderate-to-severe injuries, particularly alkali burns, because they: - Reduce inflammation and collagen remodeling - Help prevent symblepharon and entropion formation - Improve visual outcomes when used judiciously **Warning:** The statement that "systemic corticosteroids are contraindicated in ALL cases" is FALSE. While high-dose steroids must be used cautiously (risk of infection, delayed healing), they are indicated in significant chemical burns. The key is appropriate timing and dosing, not absolute contraindication. **High-Yield:** Systemic corticosteroids (e.g., prednisolone 1 mg/kg/day) are used in moderate-to-severe chemical injuries, especially alkali burns, to reduce cicatricial complications. ### Grading of Chemical Injuries (Roper Hall Classification) - **Grade I:** Corneal epithelial defect only; good prognosis - **Grade II:** Corneal haze; limbal ischemia <1/3; fair prognosis - **Grade III:** Total corneal opacity; limbal ischemia 1/3–1/2; guarded prognosis - **Grade IV:** Total corneal opacity; limbal ischemia >1/2; poor prognosis [cite:Parson's Diseases of the Eye 22e Ch 8]