Jul 4, 2019
Are you and your staff prepared to handle
ocular chemical injuries? Dr. Vincent DeLeo talks with Dr.
Shawna K. Langley and Dr. Deborah Moon about common chemical agents
used in the dermatology office that can be damaging to the eyes.
Dr. Langley shares her experience with a patient who sustained a
transient ocular injury following accidental exposure to aluminum
chloride during a biopsy of a suspicious lesion on the cheek.
Treatment protocols and prevention methods that dermatologists can
implement to ensure the best outcome for patients also are
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Things you will learn in this episode:
- On average, approximately 7%-10% of all ocular traumas may be
attributed to chemical burns.
- The two most important factors to consider when evaluating the
extent of an ocular chemical injury include the properties of the
chemical and the duration of exposure.
- Damage associated with exposure to acidic chemicals usually is
limited to more superficial consequences, while exposure to
alkaline chemicals can result in more serious long-term effects
such as cataracts or glaucoma caused by deeper penetration of the
- The most common immediate side effects of ocular chemical
injuries include a sensation of burning (not necessarily immediate)
or pain as well as redness or erythema of the eye and eventually
vision changes. “One of the learning points to me was that if
somebody complains that something has dripped in their eye, even if
it doesn’t seem possible and it doesn’t really make sense, and if
you had just worked with a caustic substance right before they said
that, have them start flushing immediately anyway,” said Dr.
- The Roper-Hall
classification outlines the prognosis based on grade of
injury (grades I-IV).
- Immediate irrigation of the eye for 15-30 minutes is the most
important variable, which will affect the patient’s long-term
prognosis. “This is the one variable that will impact the long-term
outcome the most for the patient,” said Dr. Langley.
- Always ask patients if they are wearing contact lenses, as
chemicals trapped underneath can cause prolonged burning of the
eye. Do not delay irrigation to remove contact lenses. Start
irrigation immediately and remove the lenses when possible under
- Emphasize urgent follow-up with an ophthalmologist following
ocular chemical injuries sustained in the dermatology office. If an
ophthalmologist is not immediately available, send the patient to
the emergency department.
- Educate support staff about the potential for ocular injuries
in the dermatology office and be prepared with the proper equipment
to administer immediate treatment.
Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD
(Keck School of Medicine of the University of Southern California,
Guests: Shawna K. Langley, MD (Loma Linda [Calif.] University
Medical Center; Deborah J. Moon, MD (Kaiser Permanente Los Angeles
[Calif.] Medical Center and the University of California,
Show notes by: Alicia Sonners, Melissa Sears, Elizabeth
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