ICD code 10 chemical eye burn. Thermal burn of the cornea and conjunctiva

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Thermal and chemical burns of unspecified location (T30)

general information

Short description

Thermal burns arise due to direct exposure of the skin to flame, steam, hot liquids and powerful thermal radiation.

Chemical burns occur as a result of exposure of the skin to aggressive substances, most often strong solutions of acids and alkalis, which can cause tissue necrosis within a short time.

Protocol code: E-023 "Thermal and chemical burns of the external surfaces of the body"
Profile: emergency

Purpose of the stage: stabilization of vital body functions

Code(s) according to ICD-10-10: T20-T25 Thermal burns of the external surfaces of the body, specified by their location

Included: thermal and chemical burns:

First degree [erythema]

Second degree [blisters] [loss of epidermis]

Third degree [deep necrosis of the underlying tissues] [loss of all layers of skin]

T20 Thermal and chemical burns of the head and neck

Included:

Eyes and other areas of the face, head and neck

Viska (regions)

Scalp (any area)

Nose (septum)

Ear (any part)

Limited to the area of ​​the eye and its adnexa (T26.-)

Mouth and pharynx (T28.-)

T20.0 Thermal burn of head and neck, unspecified degree

T20.1 Thermal burn of the head and neck, first degree

T20.2 Thermal burn of the head and neck, second degree

T20.3 Third degree thermal burn of head and neck

T20.4 Chemical burn of head and neck, unspecified degree

T20.5 Chemical burn of the head and neck, first degree

T20.6 Chemical burn of the head and neck, second degree

T20.7 Chemical burn of the head and neck, third degree

T21 Thermal and chemical burns of the torso

Included:

Lateral abdominal wall

Anus

Interscapular region

Mammary gland

Groin area

Penis

Labia (major) (minor)

Crotch

Back (any part)

Chest walls

Abdominal walls

Gluteal region

Excluded: thermal and chemical burns:

Scapular region (T22.-)

Armpit (T22.-)

T21.0 Thermal burn of the torso, unspecified degree

T21.1 Thermal burn of the torso, first degree

T21.2 Thermal burn of the torso, second degree

T21.3 Third degree thermal burn of torso

T21.4 Chemical burn of the torso, unspecified degree

T21.5 Chemical burn of the torso, first degree

T21.6 Chemical burn of the torso, second degree

T21.7 Chemical burn of the torso, third degree

T22 Thermal and chemical burns of the shoulder girdle and upper limb, excluding the wrist and hand

Included:

Scapular region

Axillary region

Arms (any part other than just the wrist and hand)

Excluded: thermal and chemical burns:

Interscapular region (T21.-)

Wrists and hands only (T23.-)

T22.0 Thermal burn of the shoulder girdle and upper limb, excluding the wrist and hand, unspecified degree

T22.1 Thermal burn of the shoulder girdle and upper limb, excluding the wrist and hand, first degree

T22.2 Thermal burn of the shoulder girdle and upper limb, excluding the wrist and hand, second degree

T22.3 Thermal burn of the shoulder girdle and upper limb, excluding the wrist and hand, third degree

T22.4 Chemical burn of the shoulder girdle and upper limb, excluding the wrist and hand, unspecified degree

T22.5 Chemical burn of the shoulder girdle and upper limb, excluding the wrist and hand, first degree

T22.6 Chemical burn of the shoulder girdle and upper limb, excluding the wrist and hand, second degree

T22.7 Chemical burn of the shoulder girdle and upper limb, excluding the wrist and hand, third degree

T23 Thermal and chemical burns of the wrist and hand

Included:

Thumb (nail)

Finger (nail)

T23.0 Thermal burn of wrist and hand, unspecified degree

T23.1 Thermal burn of the wrist and hand, first degree

T23.2 Thermal burn of the wrist and hand, second degree

T23.3 Third degree thermal burn of wrist and hand

T23.4 Chemical burn of wrist and hand, unspecified degree

T23.5 Chemical burn of wrist and hand, first degree

T23.6 Chemical burn of the wrist and hand, second degree

T23.7 Chemical burn of the wrist and hand, third degree

T24 Thermal and chemical burns of the hip joint and lower limb, excluding the ankle and foot

Included: legs (any part excluding ankle and foot)

Excludes: thermal and chemical burns of the ankle and foot only (T25.-)

T24.0 Thermal burn of the hip joint and lower limb, excluding the ankle and foot, unspecified degree

T24.1 Thermal burn of the hip joint and lower limb, excluding the ankle and foot, first degree

T24.2 Thermal burn of the hip joint and lower limb, excluding the ankle and foot, second degree

T24.3 Thermal burn of the hip joint and lower limb, excluding the ankle and foot, third degree

T24.4 Chemical burn of the hip joint and lower limb, excluding ankle and foot, unspecified degree

T24.5 Chemical burn of the hip joint and lower limb, excluding the ankle and foot, first degree

T24.6 Chemical burn of the hip joint and lower limb, excluding the ankle and foot, second degree

T24.7 Chemical burn of the hip joint and lower limb, excluding the ankle and foot, third degree

T25 Thermal and chemical burns of the ankle and foot area

Included: toe(s)

T25.0 Thermal burn of the ankle and foot area, unspecified degree

T25.1 Thermal burn of the ankle and foot area, first degree

T25.2 Thermal burn of the ankle and foot area, second degree

T25.3 Thermal burn of the ankle and foot area, third degree

T25.4 Chemical burn of the ankle and foot area, unspecified

T25.5 Chemical burn of the ankle and foot area, first degree

T25.6 Chemical burn of the ankle and foot area, second degree

T25.7 Chemical burn of the ankle and foot area, third degree

THERMAL AND CHEMICAL BURNS OF MULTIPLE AND UNSPECIFIED LOCALIZATION (T29-T32)

T29 Thermal and chemical burns to multiple areas of the body

Includes: thermal and chemical burns classified in more than one of T20-T28

T29.0 Thermal burns of several areas of the body, unspecified degree

T29.1 Thermal burns of multiple areas of the body, indicating no more than first degree burns

T29.2 Thermal burns of multiple areas of the body, indicating no more than second degree burns

T29.3 Thermal burns of multiple areas of the body, indicating at least one third degree burn

T29.4 Chemical burns of multiple areas of the body, unspecified degree

T29.5 Chemical burns of multiple areas of the body, indicating no more than first degree chemical burns

T29.6 Chemical burns of multiple areas of the body, indicating no more than second degree chemical burns

T29.7 Chemical burns to multiple areas of the body, indicating at least one third-degree chemical burn

T30 Thermal and chemical burns of unspecified location

Excluded: thermal and chemical burns with a specified area affected

Body surfaces (T31-T32)

T30.0 Thermal burn of unspecified degree, unspecified localization

T30.1 First degree thermal burn, unspecified location

T30.2 Thermal burn of second degree, unspecified location

T30.3 Third degree thermal burn, unspecified location

T30.4 Chemical burn of unspecified degree, unspecified location

T30.5 First degree chemical burn, unspecified location

T30.6 Chemical burn of second degree, unspecified location

T30.7 Third degree chemical burn, unspecified location

T31 Thermal burns classified according to body surface area affected

Note: this category should be used for primary statistical development only in cases where the location of the thermal burn is not specified; if the localization is clarified, this rubric, if necessary, can be used as an additional code with rubrics T20-T29

T31.0 Thermal burn of less than 10% of body surface

T31.1 Thermal burn of 10-19% body surface

T31.2 Thermal burn of 20-29% of body surface

T31.3 Thermal burn of 30-39% body surface

T31.4 Thermal burn of 40-49% body surface

T31.5 Thermal burn of 50-59% body surface

T31.6 Thermal burn of 60-69% body surface

T31.7 Thermal burn of 70-79% body surface

T31.8 Thermal burn of 80-89% body surface

T31.9 Thermal burn of 90% or more of the body surface

T32 Chemical burns classified according to body surface area affected

Note: this category should be used for primary development statistics only in cases where the location of the chemical burn is not specified; if the localization is clarified, this rubric, if necessary, can be used as an additional code with rubrics T20-T29

T32.0 Chemical burn of less than 10% of body surface

T32.1 Chemical burn of 10-19% body surface

T32.2 Chemical burn of 20-29% of body surface

T32.3 Chemical burn of 30-39% of body surface

T32.4 Chemical burn of 40-49% body surface

T32.5 Chemical burn of 50-59% body surface

T32.6 Chemical burn of 60-69% body surface

T32.7 Chemical burn of 70-79% body surface

T31.8 Chemical burn of 80-89% body surface

T32.9 Chemical burn of 90% or more of the body surface

Classification

The severity of local and general manifestations of burns depends on the depth of tissue damage and the area of ​​the affected surface.

The following degrees of burns are distinguished:

First degree burns - persistent hyperemia and infiltration of the skin.

Second degree burns - peeling of the epidermis and formation of blisters.

IIIa degree burns - partial necrosis of the skin with preservation of the deeper layers of the dermis and its derivatives.

IIIb degree burns - death of all skin structures (epidermis and dermis).

IV degree burns - necrosis of the skin and underlying tissues.

Determination of burn area:

1. "Rule of nine."

2. Head - 9%.

3. One upper limb - 9%.

4. One bottom surface - 18%.

5. Front and back surfaces of the body - 18% each.

6. Genitals and perineum - 1%.

7. The “palm” rule is conditional, the area of ​​the palm is approximately 1% of the total surface area of ​​the body.

Risk factors and groups

1. Nature of the agent.

2. Conditions for getting a burn.

3. Agent exposure time.

4. The size of the burn surface.

5. Multifactorial damage.

6. Ambient temperature.

Diagnostics

Diagnostic criteria

The depth of the burn injury is determined based on the following clinical signs.

First degree burns manifested by hyperemia and swelling of the skin, as well as a burning sensation and pain. Inflammatory changes subside within a few days, the superficial layers of the epidermis peel off, and healing begins by the end of the first week.

Second degree burns are accompanied by severe swelling and hyperemia of the skin with the formation of blisters filled with yellowish exudate. Under the epidermis, which is easily removed, there is a bright pink, painful wound surface. For chemical burns of the second degree, the formation of blisters is not typical, since the epidermis is destroyed, forming a thin necrotic film, or is completely rejected.

For third degree burns At first, either a dry light brown scab is formed (from flame burns) or a whitish-gray wet scab (exposure to steam, hot water). Sometimes thick-walled blisters filled with exudate form.

For IIIb degree burns dead tissue forms a scab: for flame burns - dry, dense, dark brown; for burns with hot liquids and steam - pale gray, soft, doughy consistency.

IV degree burns are accompanied by the death of tissues located under their own fascia (muscles, tendons, bones). The scab is thick, dense, sometimes with signs of charring.

At deep acid burns usually a dry, dense scab is formed (coagulative necrosis), and when affected by alkali, the scab is soft for the first 2-3 days (colliquation necrosis), gray in color, and later it undergoes purulent melting or dries out.

Electrical burns They are almost always deep (IIIb-IV degrees). Tissues are damaged at the points of entry and exit of current, on the contacting surfaces of the body along the path of the shortest passage of current, sometimes in the grounding zone, the so-called “current marks”, which look like whitish or brown spots, in place of which a dense scab is formed, as if pressed in relation to to surrounding intact skin.

Electrical burns are often combined with thermal burns, caused by an electric arc flash or ignition of clothing.

List of main diagnostic measures:

1. Collection of complaints and general therapeutic anamnesis.

2. General therapeutic visual examination.

3. Measurement of blood pressure in peripheral arteries.

4. Pulse examination.

5. Heart rate measurement.

6. Respiration rate measurement.

7. General therapeutic palpation.

8. General therapeutic percussion.

9. General therapeutic auscultation.

List of additional diagnostic measures:

1. Pulse oximetry.

2. Registration, interpretation and description of the electrocardiogram.

Differential diagnosis

Differential diagnosis is based on assessment of local clinical signs. It is quite difficult to determine the depth of the lesion, especially in the first minutes and hours after the burn, when there is an external similarity of different degrees of burn. The nature of the agent and the conditions under which the injury occurred must be taken into account. Absence of pain reaction when pricked with a needle, pulling out hair, touching the burned surface with an alcohol swab; the disappearance of the “play of capillaries” after short-term finger pressure indicates that the lesion is no less than grade IIIb. If a pattern of subcutaneous thrombosed veins can be seen under the dry scab, then the burn is reliably deep (IV degree).

With chemical burns, the boundaries of the lesion are usually clear, and streaks often form - narrow strips of affected skin extending from the periphery of the main lesion. The appearance of the burn area depends on the type of chemical. In case of burns with sulfuric acid, the scab is brown or black, with nitric acid it is yellow-green, and with hydrochloric acid it is light yellow. In the early stages, the smell of the substance that caused the burn may also be felt.

Treatment

Treatment tactics

The goal of treatment is to stabilize the vital functions of the body.First of all, it is necessary to stop the action of the damaging agent and removevictim from the area of ​​exposure to thermal radiation, smoke, toxic productscombustion. This is usually already done before the ambulance arrives. Soaked in hotliquid, clothing must be removed immediately.

Local hypothermia (cooling) of burned tissues immediately after cessationaction of the thermal agent contributes to the rapid reduction of interstitialtemperature, which weakens its damaging effect. For this there may bewater, ice, snow, special cooling packs were used, especially whenlimited area burns.

For chemical burns after removing clothing soaked in chemicalssubstance, and abundant washing for 10-15 minutes (if applied late, do notless than 30-40 minutes) the affected area with a large amount of running coldwater, begin to use chemical neutralizers that increaseeffectiveness of first aid. Then a dry cloth is applied to the affected areas.aseptic dressing.

Damaging agent	Means of neutralization
Lime	Lotions with 20% sugar solution
Carbolic acid	Dressings with glycerin or lime milk
Chromic acid	Dressing with 5% sodium thiosulfate solution*
Hydrofluoric acid	Dressings with %5 solution of aluminum carbonate or glycerin mixture and magnesium oxide
Borohydride compounds	Bandage with ammonia
Selenium oxide	Dressings with 10% sodium thiosulfate solution*
Aluminum-organic connections	Wiping the affected surface with gasoline, kerosene, alcohol
White phosphorus	Bandage with 3-5% solution of copper sulfate or 5% solution potassium permanganate*
Acids	Sodium bicarbonate*
Alkalis	1% acetic acid solution, 0.5-3% boric acid solution*
Phenol	40-70% ethyl alcohol*
Chromium compounds	1% hyposulfite solution
Mustard gas	2% chloramine solution, calcium hypochloride*

In case of thermal damage, clothing from burned areas is not removed, but cut and carefully removed. After this, a bandage is applied, and if it is missing, use any clean cloth. Do not clean the dressing before applying it.burnt surface from stuck clothing, remove (pierce) blisters.

To relieve pain, especially with extensive burns, for victimsSedatives must be administered - diazepam* 10 mg-2.0 ml IV (Seduxen, Elenium, Relanium,sibazon, valium), painkillers - narcotic analgesics (promedol(trimepyridine hydrochloride) 1%-2.0 ml, morphine 1%-2.0 ml, fentanyl 0.005%-1.0 ml IV),and in their absence - any painkillers (baralgin 5.0 ml IV, analgin 50% -2.0 IV, ketamine 5% - 2.0* ml IV) and antihistamines - diphenhydramine 1% -1.0ml* IV (diphenhydramine, diprazine, suprastin).

If the patient does not have nausea, vomiting, even if he does not have thirst, it is necessarypersuade to drink 0.5-1.0 liters of liquid.

Seriously ill patients with burns covering a total area of ​​more than 20% of the body surface,immediately begin infusion therapy: intravenous stream of glucose-saltsolutions (0.9% sodium chloride solution*, trisol*, 5-10% glucose solution*), in volume,ensuring stabilization of hemodynamic parameters.

Indications for hospitalization:
- first degree burns of more than 15-20% of the body surface;

Second degree burns on an area of ​​more than 10% of the body surface;
- IIIa degree burns on the areamore than 3-5% of body surface;
- burns of IIIb-IV degree;
- burns of the face, hands, feet,perineum;
- chemical burns, electrical trauma and electrical burns.

All victims who are in a state of burn shock with severe

3. *Sodium thiosulfate 30% -10.0 ml, amp.

4. *Ethyl alcohol 70% -10.0, fl.

5. *Boric acid 3% -10.0 ml, vial.

6. *Calcium hypochloride, por.

7. *Fentanyl 0.005% -1.0 ml, amp.

8. *Morphine 1% -1.0 ml, amp.

9. *Sibazon 10 mg-2.0 ml, amp.

10. * Glucose 5% -500.0 ml, vial.

11. * Trisol - 400.0 ml, fl.

* - drugs included in the list of essential (vital) medicines.

Information

Sources and literature

1. Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
   1. 1. Clinical recommendations based on evidence-based medicine: Trans. from English / Ed. Yu.L. Shevchenko, I.N. Denisova, V.I. Kulakova, R.M. Khaitova. -2nd ed., revised - M.: GEOTAR-MED, 2002. - 1248 p.: ill. 2. Guide for emergency physicians / Ed. V.A. Mikhailovich, A.G. Miroshnichenko - 3rd edition, revised and expanded - SPb.: BINOM. Knowledge Laboratory, 2005.-704p. 3. Management tactics and emergency medical care in emergency conditions. Guide for doctors./ A.L. Vertkin - Astana, 2004.-392 p. 4. Birtanov E.A., Novikov S.V., Akshalova D.Z. Development of clinical guidelines and diagnostic and treatment protocols taking into account modern requirements. Guidelines. Almaty, 2006, 44 p. 5. Order of the Minister of Health of the Republic of Kazakhstan dated December 22, 2004 No. 883 “On approval of the List of essential (vital) medicines.” 6. Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2005 No. 542 “On introducing amendments and additions to the order of the Ministry of Health of the Republic of Kazakhstan dated December 7, 2004 No. 854 “On approval of the Instructions for the formation of the List of essential (vital) medicines.”

Information

Head of the Department of Emergency and Emergency Medical Care, Internal Medicine No. 2, Kazakh National Medical University named after. S.D. Asfendiyarova - Doctor of Medical Sciences, Professor Turlanov K.M.

Employees of the Department of Ambulance and Emergency Medical Care, Internal Medicine No. 2 of the Kazakh National Medical University named after. S.D. Asfendiyarova: candidate of medical sciences, associate professor Vodnev V.P.; Candidate of Medical Sciences, Associate Professor B.K. Dyusembayev; Candidate of Medical Sciences, Associate Professor Akhmetova G.D.; candidate of medical sciences, associate professor Bedelbaeva G.G.; Almukhambetov M.K.; Lozhkin A.A.; Madenov N.N.

Head of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies - Candidate of Medical Sciences, Associate Professor Rakhimbaev R.S.

Employees of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies: Candidate of Medical Sciences, Associate Professor Silachev Yu.Ya.; Volkova N.V.; Khairulin R.Z.; Sedenko V.A.

Attached files

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RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Thermal and chemical burns limited to the eye and adnexa (T26)

Ophthalmology

general information

Short description

Recommended
Expert advice
RSE at PVC "Republican Center for Health Development"
Ministry of Health
and social development
dated October 15, 2015
Protocol No. 12

Burns limited to the area of ​​the eye and its adnexa- this is damage to the eyeball and tissues around the eye due to chemical, thermal and radiation damaging agents.

Protocol name: Thermal and chemical burns limited to the area of ​​the eye and its adnexa.

ICD-10 code(s):

T26.0 Thermal burn of the eyelid and periorbital area
T26.1 Thermal burn of the cornea and conjunctival sac
T26.2 Thermal burn leading to rupture and destruction of the eyeball
T26.3 Thermal burn of other parts of the eye and its adnexa
T26.4 Thermal burn of the eye and its adnexa, unspecified localization
T26.5 Chemical burn of the eyelid and periorbital area
T26.6 Chemical burn of the cornea and conjunctival sac
T26.7 Chemical burn leading to rupture and destruction of the eyeball
T26.8 Chemical burn to other parts of the eye and its adnexa
T26.9 Chemical burn of the eye and its adnexa, unspecified localization

Abbreviations used in the protocol:
ALT - alanine aminotransferase

AST - aspartate aminotransferase
IV - intravenous
V\m - intramuscular
GKS - glucocorticosteroids
INR - international normalized ratio
P\b - parabulbar
P\c - subcutaneously
PTI - prothrombin index
UD - level of evidence
ECG - electrocardiographic examination

Date of protocol development/revision: 2015

Protocol users: therapists, pediatricians, general practitioners, ophthalmologists.

Assessment of the degree of evidence of the recommendations provided.
Level of evidence scale:

Level evidence	Type Evidence
	The evidence comes from a meta-analysis of a large number of well-designed randomized trials. Randomized trials with low false-positive and false-negative error rates.
	The evidence is based on the results of at least one well-designed randomized trial. Randomized trials with high false-positive and false-negative error rates
III	The evidence is based on well-designed, non-randomized studies. Controlled studies with one group of patients, studies with a historical control group, etc.
	Evidence comes from non-randomized studies. Indirect comparative, descriptive correlational and case studies
V	Evidence based on clinical cases and examples

Classification

Clinical classification
Depending on the influencing factor:
· chemical;
· thermal;
· radial;
· combined.

By anatomical location of damage:
· auxiliary organs (eyelids, conjunctiva);
· eyeball (cornea, conjunctiva, sclera, underlying structures);
· several adjacent structures.

According to the severity of damage:
· I degree - mild;
· II degree - moderate degree;
· III (a and b) degrees - severe;
· IV degree - very severe.

Diagnostics

List of basic and additional diagnostic measures:
Diagnostic measures carried out at the stage of emergency care:
· collection of medical history and complaints.
Basic (mandatory) diagnostic examinations performed on an outpatient basis:
· visometry (UD - C);
· ophthalmoscopy (UD - C);

· biomicroscopy of the eye (UD - C).
Additional diagnostic examinations performed on an outpatient basis:
· perimetry (UD - C);
· tonometry (UD - C);
· echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C);

Basic (mandatory) diagnostic examinations carried out at the hospital level during emergency hospitalization and after a period of more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
· collection of complaints, medical history and life history;
· general blood analysis;
· general urine analysis;
· biochemical blood test (total protein, its fractions, urea, creatinine, bilirubin, ALT, AST, electrolytes, blood glucose);
· coagulogram (PTI, fibrinogen, FA, clotting time, INR);
· microreaction;
· blood test for HIV using ELISA method;
· determination of HBsAg in blood serum by ELISA method;
· determination of total antibodies to the hepatitis C virus in blood serum by ELISA method;
· determination of blood group according to the ABO system;
Determination of the Rh factor of blood;
· visometry (UD - C);
· ophthalmoscopy (UD - C);
· determination of corneal surface defects (UD - C);
· biomicroscopy of the eye (UD - C);
· ECG.
Additional diagnostic examinations carried out at the hospital level during emergency hospitalization and after more than 10 days have passed from the date of testing in accordance with the order of the Ministry of Defense:
· perimetry (UD - C);
· tonometry (UD - C);
· echobiometry of the eyeball, to exclude damage to the internal structures of the eyeball (UD - C)*;
· radiography of the orbit (if there are signs of combined damage to the eyelids, conjunctiva and eyeball, to exclude foreign bodies) (UD - C).

Diagnostic criteria for diagnosis:
Complaints and anamnesis
Complaints:
· pain in the eye;
· lacrimation;
· severe photophobia;
· blepharospasm;
· decreased visual acuity.
Anamnesis:
· clarification of the circumstances of the eye injury (type of burn, type of chemical substance).

Instrumental studies:
Visometry - decreased visual acuity;
· biomicroscopy - violation of the integrity of the structures of the eyeball, depending on the severity of the damage;
· ophthalmoscopy - weakening of the fundus reflex;
· determination of corneal surface defects - the area of ​​corneal damage depending on the severity of the burn;

Indications for consultation with specialists:
· consultation with a therapist - to assess the general condition of the body.

Differential diagnosis

Differential diagnosis.
Table - 1. Differential diagnosis of eye burns by severity

Burn degree	Leather	Cornea	Conjunctiva and sclera
I	skin hyperemia, superficial exfoliation of the epidermis.	islanded fluorescein staining, dull surface	hyperemia, islet staining
II	formation of blisters, peeling of the entire epidermis.	film that can be easily removed, deepithelialization, continuous staining.	pallor, gray films that are easily removed.
III a	necrosis of the superficial layers of the skin itself (up to the germ layer)	superficial opacification of the stroma and Bowman's membrane, folds of Descemet's membrane (if its transparency is preserved).	pallor and chemosis.
III in	necrosis of the entire thickness of the skin	deep clouding of the stroma, but without early changes in the iris, a sharp violation of sensitivity at the limbus.	exposure and partial rejection of the livid sclera.
IV	deep necrosis of not only the skin, but also subcutaneous tissue, muscles, and cartilage.	simultaneously with changes in the cornea up to the detachment of Descemet’s membrane (“porcelain plate”), depigmentation of the iris and immobility of the pupil, clouding of the moisture of the anterior chamber and lens.	melting of the exposed sclera to the vascular tract, clouding of the moisture of the anterior chamber and lens, vitreous body.

Table - 2. Differential diagnosis of chemical and thermal burns of the eye

Nature of damage	Alkali burn	Acid burn
type of damage	liquefaction necrosis	coagulative necrosis
intensity of primary corneal opacification	poorly expressed	strongly expressed
depth of damage	corneal opacity does not correspond to the depth of tissue damage	corneal opacity corresponds to the depth of tissue damage
damage to the cavity structures of the eye	fast	slow
development of iridocyclitis	fast	slow
neutralizers	2% boric acid solution	3% bicarbonate of soda solution

Treatment

Treatment goals:
· reduction of the inflammatory reaction of eye tissues;
· pain relief;
· restoration of the surface (epithelialization) of the eye.

Treatment tactics:
· for first degree burns - treatment is carried out on an outpatient basis, under the supervision of an ophthalmologist;
· for burns of II-IV degrees - emergency hospitalization in a hospital is indicated.

Drug treatment:
Drug treatment provided at the emergency stage:


Drug treatment provided on an outpatient basis (for burnsI degrees) :
· if there is a powdered chemical substance or its pieces on the eyelids and conjunctiva, remove it with damp cotton wool or gauze;
· local anesthetics (oxybuprocaine 0.4% or proximetacaine 0.5%), 1-2 drops into the conjunctival cavity once (UD - C);
· abundant, long-term (at least 20 minutes) rinsing of the conjunctival cavity with cool (12 0 -18 0 C) running water or water for injection (the patient’s eyes should be open while rinsing);

mydriatics (the choice of drugs is at the discretion of the doctor) - cyclopentolate 1%, tropicamide 1%, phenylephrine ophthalmic 2.5% and 10% epibulbar 1-2 drops up to 3 times a day for 3-5 days to prevent the development of inflammatory process in the anterior part of the vascular tract (UD - C);

Drug treatment provided at the inpatient level:
BurnsIIdegrees:
· local anesthetics (oxybuprocaine 0.4% or proximetacaine 0.5%) in the form of instillations before washing the conjunctival cavity, immediately before surgery, pain relief if necessary (UD - C);
· in case of a chemical burn, abundant, long-term (at least 20 minutes), continuous irrigation of the conjunctival cavity with a neutralizer for alkalis (2% boric acid solution or 5% citric acid solution or 0.1% lactic acid solution or 0.01% acetic acid solution), for acids ( 2% sodium bicarbonate solution). Chemical neutralizers are used during the first hours after a burn; subsequently, the use of these drugs is inappropriate and can have a damaging effect on the burned tissue (UD - C);
· in case of a thermal burn, rinse with cool (120-180C) running water/water for injection (the patient’s eyes should be open while rinsing).
· washing is not carried out in case of a thermochemical burn when a penetrating wound is detected;
· local antibacterial agents (chloramphenicol ophthalmic 0.25% or ciprofloxacin ophthalmic 0.3% or ofloxacin ophthalmic 0.3%) - for children over 1 year of age and adults immediately after washing the conjunctival cavity, as well as 1 drop 4 times a day epibulbarically in for 5-7 days (to prevent infectious complications) (UD - C);
· antibacterial agents for local external use (ofloxacin ophthalmic 0.3% or tobramycin 0.3%) - for children over 1 year and adults 2-3 times a day on the burn surface (according to indications) (UD - C);
· non-steroidal anti-inflammatory drugs (diclofenac ophthalmic 0.1%) - 1 drop 4 times a day epibulbarically (in the absence of epithelial defects) for 8-10 days. (UD - C);
mydriatics - atropine ophthalmic 1% (adults), 0.5%, 0.25%, 0.125% (children) 1 drop 1 time per day epibulbarically, cyclopentolate 1%, tropicamide 1%, phenylephrine ophthalmic 2.5% and 10% epibulbar 1-2 drops up to 3 times a day for the purpose of prevention and treatment of the inflammatory process in the anterior part of the vascular tract (UD - C);
· regeneration stimulants, keratoprotectors (dexpanthenol 5 mg) - 1 drop 3 times a day epibulbar. In order to improve the trophism of the anterior surface of the eyeball, accelerate the healing of erosions (UD - C);
· with increased intraocular pressure: non-selective “B” blockers (timolol 0.25% and 0.5%) -. Contraindicated for: bronchial obstruction, bradycardia less than 50 beats per minute, systemic hypotension; Carbonic anhydrase inhibitors (dorzolamide 2%, or brinzolamide 1%) - epibulbar 1 drop 2 times a day (UD - C);
· for pain - analgesics (ketorolac 1 ml i.m.) as needed (UD - C);

BurnsIII- IVdegrees(additionally assigned to the above):
· antitetanus serum 1500-3000 IU subcutaneously to reduce intoxication when a burn wound is contaminated;
· non-steroidal anti-inflammatory drugs - diclofenac 50 mg orally 2-3 times a day before meals, course 7-10 days (UD - C);
· GCS (dexamethasone 0.4%) sub 0.5 ml daily/every other day (not earlier than 5-7 days - according to indications, not in the acute phase triamcinolone 4% 0.5 ml sub 1 time). For anti-inflammatory, anti-edematous, anti-allergic, anti-exudative purposes (UD - C);
· antibacterial drugs (according to indications for severe burns in stages 1 and 2 of burn disease) enterally/parenterally - azithromycin 250 mg, 500 mg - 1 TB 2 times a day for 5-7 days, 0.5 or 0.25 ml i.v. once a day for 3 days; cefuroxime 750 mg 2 times a day for 5-7 days, ceftriaxone 1.0 IV 1 time a day for 5-7 days (LE - C).

Non-drug treatment:
· general mode II-III, table No. 15.

Surgical intervention:
Surgical interventions for eye burnsIII- IV stages:
· conjunctivotomy;
· necrectomy of the conjunctiva and cornea;
· blepharoplasty, blepharorrhaphy;
· layer-by-layer and penetrating keratoplasty, bio-coating of the cornea.

Surgical intervention provided in an inpatient setting:

Conjunctivotomy(ICD-9: 10.00, 10.10, 10.33, 10.99) :
Indications:
· pronounced swelling of the conjunctiva;
risk of limbal ischemia.
Contraindications:
general somatic status.

Necrectomy of the conjunctiva and cornea(ICD-9: 10.31, 10.41, 10.42, 10.43, 10.44, 10.49, 10.50, 10.60, 10.99, 11.49) .
Indications:
· the presence of foci of necrosis.
Contraindications:
general somatic status.

Blepharoplasty(early primary), blepharorrhaphy(ICD-9: 08.52, 08.59, 08.61, 08.62, 08.64, 08.69, 08.70, 08.71, 08.72, 08.73, 08.74, 08.89, 08.99):
Indications:
· severe burn injuries to the eyelids, with the impossibility of complete closure of the palpebral fissure;
Contraindications:
general somatic status.

Layered/penetrating keratoplasty, bio-coating of the cornea(ICD-9: 11.53, 11.59, 11.61, 11.62, 11.63, 11.64, 11.69, 11.99).
Indications:
· threat of perforation/perforation of the cornea, for therapeutic and organ-preserving purposes.
Contraindications:
general somatic status.

Further management:
· for mild burns, outpatient treatment under the supervision of an outpatient ophthalmologist;
· after the end of inpatient treatment, the patient is registered with an ophthalmologist at the place of residence (up to 1 year) with the necessary recommendations (volume and frequency of dispensary examinations).
· reconstructive surgery (not earlier than a year after the injury) - plastic surgery of the eyelids, conjunctival cavity, keratoprosthesis, keratoplasty.

Indicators of treatment effectiveness:
· relief of the inflammatory process;
Complete epithelization of the cornea;
· restoration of corneal transparency;
· increased visual functions;
· absence of cicatricial changes in the eyelid and conjunctiva;
· absence of secondary complications;
· formation of a vascularized corneal cataract.

Drugs (active ingredients) used in treatment

Azithromycin

Atropine

Boric acid

Brinzolamide

Dexamethasone

Dexpanthenol

Diclofenac

Dorzolamide

Ketorolac

Citric acid

Lactic acid

Sodium hydrocarbonate

Oxybuprocaine

Ofloxacin

Proxymetacaine

Antitetanus serum (Serum tetanus)

Timolol

Tobramycin

Tropicamide

Acetic acid

Phenylephrine

Chloramphenicol

Ceftriaxone

Cefuroxime

Cyclopentolate

Ciprofloxacin

Hospitalization

Indications for hospitalization indicating the type of hospitalization:

Indications for emergency hospitalization:
· burns of the eyes and its appendages of moderate or greater severity.
Indications for planned hospitalization: No

Information

Sources and literature

1. Minutes of meetings of the Expert Council of the RCHR of the Ministry of Health of the Republic of Kazakhstan, 2015
   1. List of used literature (valid research links to the listed sources in the text of the protocol are required): 1) Eye diseases: textbook / Under. ed. V.G. Kopaeva. – M.: Medicine, 2002. – 560 p. 2) Dzhaliashvili O.A., Gorban A.I. First aid for acute diseases and eye injuries. – 2nd ed., revised. and additional – St. Petersburg: Hippocrates, 1999. – 368 p. 3) Puchkovskaya N.A., Yakimenko S.A., Nepomnyashchaya V.M. Eye burns. – M.: Medicine, 2001. – 272 p. 4) Ophthalmology: national guide / Ed. S.E. Avetisova, E.A. Egorova, L.K. Moshetova, V.V. Neroeva, Kh.P. Takhchidi. – M.: GEOTAR-Media, 2008. – 944 p. 5) Egorov E.A., Alekseev V.N., Astakhov Yu.S., Brzhesky V.V., Brovkina A.F., et al. Rational pharmacotherapy in ophthalmology: a guide for practicing doctors / Under the general. ed. E.A. Egorova. – M.: Litterra, 2004. – 954 p. 6) Atkov O.Yu., Leonova E.S. Patient management plans “Ophthalmology” Evidence-based medicine, GEOTAR - Media, Moscow, 2011, pp. 83-99. 7) Guideline: Work Loss Data Institute. Eye. Encinitas (CA): Work Loss Data Institute; 2010. Various p. 8) Egorova E.V. et al. Technology of surgical interventions for extensive post-traumatic defects and deformations in the eyelid area \\ Mater. 111 Euro-Asian Conf. in ophthalmic surgery. – 2003, Ekaterinburg. - With. 33

Information

List of protocol developers with qualification information:

1) Isergepova Botagoz Iskakovna - Candidate of Medical Sciences, Head of the Department of Management of Scientific and Innovative Research of JSC “Kazakh Research Institute of Eye Diseases”.
2) Makhambetov Dastan Zhakenovich - ophthalmologist of the first category, JSC “Kazakh Research Institute of Eye Diseases”.
3) Gulnara Kenesovna Mukhamedzhanova - Candidate of Medical Sciences, assistant at the Department of Ophthalmology of the RSE at the Kazakh National Medical University. Asfendiyarova S.D.”
4) Zhusupova Gulnara Darigerovna - candidate of medical sciences, associate professor of the department of JSC "Astana Medical University".

Disclosure of no conflict of interest: No

Reviewer: Shusterov Yuri Arkadyevich - Doctor of Medical Sciences, Professor, RSE at Karaganda State Medical University, Head of the Department of Ophthalmology.

Indication of the conditions for reviewing the protocol:
Review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

Attached files

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15-10-2012, 06:52

Description

SYNONYMS

Chemical, thermal, radiation damage to the eyes.

ICD-10 CODE

T26.0. Thermal burn of the eyelid and periorbital area.

T26.1. Thermal burn of the cornea and conjunctival sac.

T26.2. Thermal burn leading to rupture and destruction of the eyeball.

T26.3. Thermal burn of other parts of the eye and its adnexa.

T26.4. Thermal burn of the eye and its adnexa of unspecified localization.

T26.5. Chemical burn of the eyelid and periorbital area.

T26.6. Chemical burn of the cornea and conjunctival sac.

T26.7. Chemical burn leading to rupture and destruction of the eyeball.

T26.8. Chemical burn to other parts of the eye and its adnexa.

T26.9. Chemical burn of the eye and its adnexa of unspecified localization.

T90.4. Consequence of eye injury in the periorbital region.

CLASSIFICATION

• I degree- hyperemia of various parts of the conjunctiva and limbus, superficial erosions of the cornea, as well as hyperemia of the skin of the eyelids and their swelling, slight swelling.
• II degree b - ischemia and superficial necrosis of the conjunctiva with the formation of easily removable whitish scabs, clouding of the cornea due to damage to the epithelium and superficial layers of the stroma, the formation of blisters on the skin of the eyelids.
• III degree- necrosis of the conjunctiva and cornea to the deep layers, but not more than half the surface area of ​​the eyeball. The color of the cornea is “matte” or “porcelain”. Changes in ophthalmotonus are noted in the form of a short-term increase in IOP or hypotension. Possible development of toxic cataracts and iridocyclitis.
• IV degree- deep damage, necrosis of all layers of the eyelids (up to charring). Damage and necrosis of the conjunctiva and sclera with vascular ischemia on the surface of more than half of the eyeball. The cornea is “porcelain”, a tissue defect of more than 1/3 of the surface area is possible, in some cases a perforation is possible. Secondary glaucoma and severe vascular disorders - anterior and posterior uveitis.

ETIOLOGY

Conventionally, chemical (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and radiation burns are distinguished.

CLINICAL PICTURE

Common signs of eye burns:

• the progressive nature of the burn process after the cessation of exposure to the damaging agent (due to metabolic disorders in the tissues of the eye, the formation of toxic products and the occurrence of an immunological conflict due to autointoxication and autosensitization to the post-burn period);
• tendency to relapse of the inflammatory process in the choroid at various times after receiving a burn;
• a tendency to the formation of synechiae, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.

Stages of the burn process:

• Stage I (up to 2 days) - rapid development of necrobiosis of affected tissues, excess hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acidic polysaccharides;
• Stage II (2-18 days) - manifestation of pronounced trophic disorders due to fibrinoid swelling:
• Stage III (up to 2-3 months) - trophic disorders and vascularization of the cornea due to tissue hypoxia;
• Stage IV (from several months to several years) is a period of scarring, an increase in the amount of collagen proteins due to increased synthesis by corneal cells.

DIAGNOSTICS

The diagnosis is made based on the history and clinical picture.

TREATMENT

Basic principles of treating eye burns:

• provision of emergency care aimed at reducing the damaging effect of the burn agent on tissue;
• subsequent conservative and (if necessary) surgical treatment.

When providing emergency care to a victim, it is necessary to intensively rinse the conjunctival cavity with water for 10-15 minutes, with obligatory eversion of the eyelids and rinsing of the lacrimal ducts, and careful removal of foreign particles.

Washing is not carried out in case of a thermochemical burn if a penetrating wound is detected!

Surgical interventions on the eyelids and eyeball in the early stages are carried out only for the purpose of preserving the organ. Vitrectomy of burned tissues, early primary (in the first hours and days) or delayed (after 2-3 weeks) blepharoplasty with a free skin flap or a skin flap on a vascular pedicle with a simultaneous transplantation of automucous tissue to the inner surface of the eyelids, fornix and sclera are performed.

Planned surgical interventions on the eyelids and eyeball for the consequences of thermal burns are recommended to be carried out 12-24 months after the burn injury, since against the background of autosensitization of the body, allosensitization to the graft tissue occurs.

For severe burns, it is necessary to inject 1500-3000 IU of antitetanus serum subcutaneously.

Treatment of stage I eye burns

Long-term irrigation of the conjunctival cavity (for 15-30 minutes).

Chemical neutralizers are used in the first hours after a burn. Subsequent use of these drugs is inappropriate and can have a damaging effect on the burned tissue. The following means are used for chemical neutralization:

• alkali - 2% boric acid solution, or 5% citric acid solution, or 0.1% lactic acid solution, or 0.01% acetic acid:
• acid - 2% sodium bicarbonate solution.

For severe symptoms of intoxication, Belvidon 200-400 ml is prescribed intravenously once a day, 200-400 ml at night (up to 8 days after injury), or a 5% dextrose solution with ascorbic acid 2.0 g in a volume of 200-400 ml, or 4- 10% dextran solution [cf. they say weight 30,000-40,000], 400 ml intravenously.

NSAIDs

H1 receptor blockers: chloropyramine (orally 25 mg 3 times a day after meals for 7-10 days), or loratadine (orally 10 mg once a day after meals for 7-10 days), or fexofenadine (orally 120-180 mg once a day after meals for 7-10 days).

Antioxidants: methylethylpyridinol (1% solution, 1 ml intramuscularly or 0.5 ml parabulbarly once a day, for a course of 10-15 injections).

Analgesics: metamizole sodium (50%, 1-2 ml intramuscularly for pain) or ketorolac (1 ml intramuscularly for pain).

Preparations for instillation into the conjunctival cavity

In severe conditions and in the early postoperative period, the frequency of instillations can reach 6 times a day. As the inflammatory process decreases, the duration between instillations increases.

Antibacterial agents: ciprofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or ofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or tobramycin 0.3% ( eye drops, 1-2 drops 3-6 times a day).

Antiseptics: picloxidine 0.05% 1 drop 2-6 times a day.

Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone (eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisolone (eye drops 0.5% 1-2 drops 3-6 times a day).

NSAIDs: diclofenac (orally 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (orally 25 mg 2-3 times a day after meals, course 10-14 days).

Midriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day) in combination with phenylephrine (eye drops 2 .5% 2-3 times a day for 7-10 days).

Stimulators of corneal regeneration: actovegin (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or solcoseryl (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or dexpanthenol (eye gel 5% for the lower eyelid eyelid 1 drop 2-3 times a day).

Surgery: sectoral conjunctivotomy, corneal paracentesis, conjunctival and corneal necrectomy, genoplasty, corneal biocovering, eyelid plastic surgery, lamellar keratoplasty.

Treatment of stage II eye burns

Groups of drugs that stimulate immune processes, improve the body’s utilization of oxygen and reduce tissue hypoxia are added to the treatment.

Fibrinolysis inhibitors: aprotinin 10 ml intravenously, for a course of 25 injections; instillation of the solution into the eye 3-4 times a day.

Immunomodulators: levamisole 150 mg 1 time per day for 3 days (2-3 courses with a break of 7 days).

Enzyme preparations: systemic enzymes, 5 tablets 3 times a day, 30 minutes before meals, with 150-200 ml of water, the course of treatment is 2-3 weeks.

Antioxidants: methylethylpyridinol (1% solution, 0.5 ml parabulbarly, 1 time per day, for a course of 10-15 injections) or vitamin E (5% oil solution, 100 mg orally, 20-40 days).

Surgery: layered or penetrating keratoplasty.

Treatment of stage III eye burns

The following are added to the treatment described above.

Short-acting mydriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day).

Antihypertensive drugs: betaxolol (0.5% eye drops, 2 times a day), or timolol (0.5% eye drops, 2 times a day), or dorzolamide (2% eye drops, 2 times a day).

Surgery: keratoplasty for emergency indications, antiglaucomatous operations.

Treatment of stage IV eye burns

The following are added to the treatment:

Glucocorticoids: dexamethasone (parabulbar or under the conjunctiva, 2-4 mg, for a course of 7-10 injections) or betamethasone (2 mg betamethasone disodium phosphate + 5 mg betamethasone dipropionate) parabulbar or under the conjunctiva 1 time per week 3-4 injections. Triamcinolone 20 mg once a week, 3-4 injections.

Enzyme preparations in the form of injections:

• fibrinolysin [human] (400 units parabulbar):
• collagenase 100 or 500 KE (the contents of the bottle are dissolved in 0.5% procaine solution, 0.9% sodium chloride solution or water for injection). Injected subconjunctivally (directly into the lesion: adhesions, scar, ST, etc. using electrophoresis, phonophoresis, and also applied cutaneously. Before use, check the sensitivity of the patient, for which 1 KE is injected under the conjunctiva of the diseased eye and observed for 48 hours. In the absence of an allergic reaction, treatment is carried out for 10 days.

Non-drug treatment

Physiotherapy, eyelid massage.

Approximate periods of incapacity for work

Depending on the severity of the lesion, it takes 14-28 days. Disability is possible if complications or loss of vision occur.

Further management

Observation by an ophthalmologist at your place of residence for several months (up to 1 year). Monitoring of ophthalmotonus, CT state, retina. If there is a persistent increase in IOP and there is no compensation with medication, antiglaucomatous surgery is possible. With the development of traumatic cataracts, removal of the cloudy lens is indicated.

FORECAST

Depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the victim’s admission to the hospital, and the correctness of drug therapy.

Article from the book: .

Chemical burns to the organs of vision occur due to contact with aggressive chemicals. They lead to damage to the anterior part of the eyeball, cause unpleasant symptoms: pain, irritation and can lead to vision problems.

An eye burn is not a disease, but a pathological condition that can be eliminated if you consult an ophthalmologist in time.

List of symptoms:

1. Sharp pain in the eyes. But this information will help you understand why pain occurs in the eyeball when pressing.
2. Redness of the conjunctiva.
3. Discomfort, burning sensation, irritation.
4. Increased tear production.

It is difficult not to notice chemical damage to the organ of vision. It's all about pronounced symptoms, which gradually increase.

Chemical substances act gradually. Once on the skin of the eyes, they cause irritation, but if the burn is left unattended, its manifestations will only intensify.

Aggressive reagents gradually damage the skin of the eyelids and eyes. The extent of the “injuries” inflicted and their severity can be assessed after 2–3 days. But what types of eyelid diseases there are in humans and what drops should be used are indicated in this article.

Classification of burns

The video shows a description of a chemical burn to the eye:

Clinical manifestations

1. Damage to the surface of the skin of the eyelids.
2. The presence of foreign substances in the tissues of the conjunctiva. But what the symptoms of eye conjunctivitis in children may be can be seen here.
3. Increased intraocular pressure (ocular hypertension).

Extensive damage to the skin occurs upon contact with reagents. The substances irritate the mucous membrane, which leads to redness and irritation of the anterior parts of the eyeball.

During an ophthalmological examination, particles of foreign substances are detected; they are clearly visible during a clinical examination. Carrying out research helps to determine which substance led to the development of damage (acid, alkali).

The reagents act on parts of the eyeball in a special way. Contact results in “desiccation” or drying out of the mucosal surface and an increase in intraocular pressure levels. But what are the symptoms of high eye pressure in adults is described in great detail in this article.

Assessing the totality of symptoms helps to make the correct diagnosis for the patient. An ophthalmologist determines the degree of burn, performs diagnostic procedures and selects adequate treatment.

ICD-10 code

• T26.5 – chemical burn and area around the eyelid;
• T26.6 – chemical burn with reagents with damage to the cornea and conjunctival sac;
• T26.7 – severe chemical burn with tissue damage leading to rupture of the eyeball;
• T26.8 – chemical burn affecting other parts of the eye;
• T26.9 - a chemical burn that affected the deep parts of the eyeball.

If the tissues of the eyeball, eyelids and conjunctiva are damaged, the patient needs first aid.

So, the principles of its provision:

Do not wash your eyes with running water or use cosmetic creams. This may increase signs of chemical exposure.

Once on the skin, the cream creates a protective shell on top, as a result of which the effect of aggressive reagents is enhanced. For this reason, you should not apply creams or other cosmetics to the skin.

What medications can you use:

The potassium permanganate solution should be weak, it will help neutralize the effect of aggressive substances. You can dilute potassium permanganate, prepare furatsilin, or simply rinse your vision with warm, slightly salted water.

You should wash your eyes as often as possible, every 20–30 minutes. If the symptoms are severe, then you can take painkillers: Ibuprofen, Analgin or any other painkillers.

Treatment

It is advisable to consult a doctor when the first signs of a chemical burn appear. The doctor will select adequate therapy and help reduce unaccepted symptoms.

Most often the following drugs are prescribed for treatment:

Antiseptics are part of combination therapy; they stop the inflammatory process and promote the restoration of soft tissues, relieve swelling and redness.

Antibacterial drugs are prescribed to relieve the inflammatory process. They promote the death of pathogenic microflora and accelerate the process of cell regeneration.

Anti-inflammatory drugs also include glucocorticosteroids; they enhance the effect of antibacterial medications and antiseptics. With regular use, they reduce the intensity of unpleasant symptoms.

Local anesthetics are used in the form of drops. They help reduce the intensity of pain.

If there is an increase in the level of intraocular pressure (most often diagnosed upon contact with alkalis), then medications are used that reduce the signs of intraocular hypertension.

Medicines based on human tears. They help soften the irritated conjunctiva and reduce signs of the inflammatory process, remove swelling and partially hyperthermia of the eyelid.

List of drugs prescribed for eye burns:

Solcoseryl is available in the form of an ointment; the drug significantly speeds up the healing process and helps to avoid pronounced scarring of the tissue. And taurine as a substance “inhibits” the development of irreversible changes in the parts of the eyeball.

Timolol is the substance that ophthalmologists prefer when signs of high intraocular pressure appear.

What to do if a chemical burn to the eye occurs after eyelash extensions?

Getting burned while doing eyelash extensions occurs for several reasons. This can be caused by heat - thermal damage or chemicals (contact with the skin of the eyelids or mucous membranes of glue).

If you have problems with eyelash extensions, you should carry out the following procedures:

• rinse your eyes with a solution of potassium permanganate. But what to use to wash your eye if you get a speck of debris in it, the information in the link will help you understand.
• drip Taurine or any other drops into the eyeballs to reduce the inflammatory process (you can use drugs based on human tears);
• consult a doctor for help.

If the damage is local, then contacting an ophthalmologist is necessary. Since only a doctor will be able to assess the seriousness of the situation and provide the patient with adequate assistance.

In the video there is an eye burn after eyelash extensions:

If glue gets on the skin, there is a possibility of developing blepharitis and other inflammatory diseases. To prevent this from happening, it is necessary to take appropriate measures and consult an ophthalmologist as soon as possible. But how to properly use Kosopt eye drops and what their price is can be seen in this article.

You will also need to remove the eyelash extensions, since the glue irritates the skin of the eyelids and leads to increased unpleasant symptoms.

A chemical burn to the organs of vision is a serious injury that requires immediate treatment. You can provide first aid yourself, but subsequent treatment should preferably be carried out under the supervision of a doctor.

okulist.online

Thermal and chemical burns limited to the area of ​​the eye and its adnexa

ICD-10 → S00-T98 → T20-T32 → T26-T28 → T26.0

Thermal burn of the eyelid and periorbital area

Thermal burn of the cornea and conjunctival sac

Thermal burn leading to rupture and destruction of the eyeball

Thermal burn of other parts of the eye and its adnexa

Thermal burn of the eye and its adnexa of unspecified localization

Chemical burn of the eyelid and periorbital area

Chemical burn of the cornea and conjunctival sac

Chemical burn leading to rupture and destruction of the eyeball

Chemical burn to other parts of the eye and its adnexa

Chemical burn of the eye and its adnexa of unspecified localization

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International statistical classification of diseases and related health problems. 10th revision.

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ICD-10, T26, thermal and chemical burns limited to the area of ​​the eye and its adnexa

More information about the ICD-10 classifier

Date of placement in the database 03/22/2010

Relevance of the classifier: 10th revision of the International Classification of Diseases

Showing 10 entries

Home → INJURIES, POISONING AND SOME OTHER CONSEQUENCES OF EXTERNAL CAUSES → THERMAL AND CHEMICAL BURNS → THERMAL AND CHEMICAL BURNS OF THE EYE AND INTERNAL ORGANS → Thermal and chemical burns limited to the area of ​​the eye and its appendages apparatus

Code Name

T26.0	Thermal burn of the eyelid and periorbital area
T26.1	Thermal burn of the cornea and conjunctival sac
T26.2	Thermal burn leading to rupture and destruction of the eyeball
T26.3	Thermal burn of other parts of the eye and its adnexa
T26.4	Thermal burn of the eye and its adnexa of unspecified localization
T26.5	Chemical burn of the eyelid and periorbital area
T26.6	Chemical burn of the cornea and conjunctival sac
T26.7	Chemical burn leading to rupture and destruction of the eyeball
T26.8	Chemical burn to other parts of the eye and its adnexa
T26.9	Chemical burn of the eye and its adnexa of unspecified localization

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