PDF herunterladen
Klin Monbl Augenheilkd 2015; 5(02): 127-144
DOI: 10.1055/s-0041-100770
Bindehaut, Hornhaut, Lederhaut
Georg Thieme Verlag KG Stuttgart · New York

Augenverätzungen

Chemical Ocular Burns
N. Schrage
An-Institut der RWTH Aachen
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
27. Mai 2015 (online)

Auch verfügbar auf
    Lizenzen und Reprints Alle Artikel dieser Rubrik

Siehe auch:

AugenverätzungenKlin Monbl Augenheilkd 2015; 232(07): 895-914
DOI: 10.1055/s-0033-1358126

Die Läsion einer Verätzung und Verbrennung des Auges entsteht durch eine chemische oder physikalische Überlastung der Abwehrkräfte der Augenoberflächen.

Die Gradierung einer Verätzung und Verbrennung reicht vom nur spürbaren Reiz mit Jucken und Brennen über erst sichtbare Veränderungen wie Rötung bis zur Gewebsverletzung mit Verlust von Gewebeanteilen und Nekrosen. Toxikologisch wird die Bewertung einer Verätzung mit Irritation bis hin zur nicht heilenden Verletzung bewertet.

Um Verätzungen und Verbrennungen zu verstehen und adäquat zu behandeln, möchten wir zunächst die Mechanismen von Gewebsschädigung durch physikalische und chemische Einflüsse beschreiben, um dann die klinische Phänomenologie parallel zu den Bewertungen der toxikologischen Substanzklassen nach GHS (global harmonized System) einzuführen. Danach werden die adäquate Erstbehandlung und die folgende spezielle Nachbehandlung der Verätzungskrankheit beschrieben.

 

  • Literatur

  • 1 Aachener Centrum für Technologietransfer in der Ophthalmologie – ACTO. Verätzungen. Im Internet: http://www.acto.de Stand: 1.4.2015
  • 2 Aslund F, Berndt KD, Holmgren A. Redox potentials of glutaredoxins and other thiol-disulfide oxidoreductases of the thioredoxin superfamily determined by direct protein-protein redox equilibria. J Biol Chem 1997; 272: 30780-30786
    CrossrefPubMedSuche in Google Scholar
  • 3 Becker J, Salla S, Dohmen U et al. Explorative study of interleukin levels in the human cornea. Graefes Arch Clin Exp Ophthalmol 1995; 233: 766-771
    CrossrefPubMedSuche in Google Scholar
  • 4 Beiran I, Miller B, Bentur Y. The efficacy of calcium gluconate in ocular hydrofluoric acid burns. Hum Exp Toxicol 1997; 16: 223-228
    CrossrefPubMedSuche in Google Scholar
  • 5 Bernauer W, Thiel MA, Kurrer M et al. Corneal calcification following intensified treatment with sodium hyaluronate artificial tears. Br J Ophthalmol 2006; 90: 285-288
    CrossrefPubMedSuche in Google Scholar
  • 6 Block S, Sikder SP, Herretes P et al. Topical human amniotic: inhibition of induced corneal neovascularization. ARVO Abstr 1650 Fort Lauderdale ARVO Meeting 2006.
  • 7 Böhmer JA, Sellhaus B, Schrage NF. Effects of ascorbic acid on retinal pigment epithelial cells. Corr Eye Res 2001; 23: 206-214
    Suche in Google Scholar
  • 8 Bramsen T, Ehlers N. Early postoperative changes in graft thickness after penetrating keratoplasty. Influence of host corneal disorder on time course. Acta Ophthalmol (Copenh) 1979; 57: 258-268
    Suche in Google Scholar
  • 9 Cejková J, Stípek S, Crkovská J et al. Changes of superoxide dismutase, catalase and glutathione peroxidase in the corneal epithelium after UVB rays. Histochemical and biochemical study. Histol Histopathol 2000; 15: 1043-1050
    PubMedSuche in Google Scholar
  • 10 Chung JH. Healing of rabbit corneal alkali wounds in vitro. Cornea 1990; 9: 36-40
    CrossrefPubMedSuche in Google Scholar
  • 11 Den S, Sotozono C, Kinoshita S et al. Efficacy of early systemic betamethasone or cyclosporin A after corneal alkali injury via inflammatory cytokine reduction. Acta Ophthalmol Scand 2004; 82: 195-199
    CrossrefPubMedSuche in Google Scholar
  • 12 Gerard M, Merle H, Ayeboua L et al. [Prospective study of eye burns at the Fort de France University Hospital]. J Fr Ophtalmol 1999; 22: 834-847
    PubMedSuche in Google Scholar
  • 13 Gerard M, Louis V, Merle H et al. Experimental study about intra-ocular penetration of ammonia. J Fr Ophtalmol 1999; 22: 1047-1053
    PubMedSuche in Google Scholar
  • 14 Green K, Paterson CA, Siddiqui A. Ocular blood flow after experimental alkali burns and prostaglandin administration. Arch Ophthalmol 1985; 103: 569-571
    CrossrefPubMedSuche in Google Scholar
  • 15 Hall AH, Blomet J, Gross M et al. Hexafluorine for emergency decontamination of hydrofluoric acid eye/skin splashes. SSA J (Semiconduct Safe Assoc J) 2000; 14: 30-33
    Suche in Google Scholar
  • 16 Hellmann M. Augenverätzungen durch verschiedene Verätzungsagentien unter epidemiologischen Gesichtspunkten. Promotion RWTH Aachen Universitätsklinik, 7. 4. 2008. Erhebungszeitraum 2001 – 2007.
  • 17 Hermel M, Heckelen A, Kirchhof B et al. Inhibitory effect of ascorbic acid on human retinal pigment epithelial cell proliferation compared to cytostatic drugs—influence of histamine. Inflamm Res 2001; 50 Suppl 2: S93-S95
    PubMedSuche in Google Scholar
  • 18 Hojer J, Personne M, Hulten P et al. Topical treatments for hydrofluoric acid burns: a blind controlled experimental study. J Toxicol Clin Toxicol 2002; 40: 861-866
    CrossrefPubMedSuche in Google Scholar
  • 19 Jayamanne DG, Bell RW. Non-penetrating corneal foreign body injuries: factors affecting delay in rehabilitation of patients. J Accid Emerg Med 1994; 11: 195-197
    CrossrefPubMedSuche in Google Scholar
  • 20 Koh HJ, Kim SH, Kwon OW. Inadvertent topical exposure to isocyanates caused damage to the entire eyeball. Korean J Ophthalmol 2000; 14: 38-40
    CrossrefPubMedSuche in Google Scholar
  • 21 Kompa S, Redbrake C, Dunkel B et al. Corneal calcification after chemical eye burns caused by eye drops containing phosphate buffer. Burns 2006; 32: 744-747
    CrossrefPubMedSuche in Google Scholar
  • 22 Kompa S, Redbrake C, Langefeld S et al. The type II Aachen-Keratoprosthesis in humans: case report of the first prolonged application. Int J Artif Organs 2001; 24: 110-114
    CrossrefPubMedSuche in Google Scholar
  • 23 Kompa S, Schareck B, Tympner J et al. Comparison of emergency eye-wash products in burned porcine eyes. Graefes Arch Clin Exp Ophthalmol 2002; 240: 308-313
    CrossrefPubMedSuche in Google Scholar
  • 24 Kubota M, Fagerholm P. Corneal alkali burn in the rabbit. Waterbalance, healing and transparency. Acta Ophthalmol (Copenh) 1991; 69: 635-640
    Suche in Google Scholar
  • 25 Kuckelkorn R, Makropoulos W, Kottek A et al. [Retrospective study of severe alkali burns of the eyes]. Klin Monatsbl Augenheilkd 1993; 203: 397-402
    Thieme ConnectPubMedSuche in Google Scholar
  • 26 Kuckelkorn R, Kottek A, Reim M. [Intraocular complications after severe chemical burns—incidence and surgical treatment]. Klin Monatsbl Augenheilkd 1994; 205: 86-92
    Thieme ConnectPubMedSuche in Google Scholar
  • 27 Kuckelkorn R, Kottek A, Schrage N et al. Poor prognosis of severe chemical and thermal eye burns: the need for adequate emergency care and primary prevention. Int Arch Occup Environ Health 1995; 67: 281-284
    CrossrefPubMedSuche in Google Scholar
  • 28 Langefeld S, Reim M, Redbrake C et al. The corneal stroma: an inhomogeneous structure. Graefes Arch Clin Exp Ophthalmol 1997; 235 (8) 480-485
    CrossrefPubMedSuche in Google Scholar
  • 29 Laux U, Roth HW, Krey H et al. Die Wasserstoffkonzentration des Kammerwassers nach Alkaliverätzungen der Hornhaut und deren therapeutische Beeinflußbarkeit. Eine tierexperimentelle Studie. Albrecht von Graefes Arch Clin Exp Ophthalmol 1975; 195: 33-40
    Suche in Google Scholar
  • 30 Lee SJ, Jang JW, Lee WC et al. Perforating disorder caused by salt-water application and its experimental induction. Int J Dermatol 2005; 44: 210-214
    CrossrefPubMedSuche in Google Scholar
  • 31 Liston RL, Olson RJ, Mamalis N. A comparison of rust-ring removal methods in a rabbit model: small-gauge hypodermic needle versus electric drill. Ann Ophthalmol 1991; 23: 24-27
    PubMedSuche in Google Scholar
  • 32 Luo L, Li DQ, Corrales RM et al. Hyperosmolar saline is a proinflammatory stress on the mouse ocular surface. Eye Contact Lens 2005; 31 (5) 186-193
    CrossrefPubMedSuche in Google Scholar
  • 33 Mathieu L, Nehles J, Blomet J et al. Efficacy of hexafluorine for emergent decontamination of hydrofluoric acid eye and skin splashes. Vet Hum Toxicol 2001; 43: 263-265
    PubMedSuche in Google Scholar
  • 34 Maurer JK, Molai A, Parker RD et al. Pathology of ocular irritation with bleaching agents in the rabbit low-volume eye test. Toxicol Pathol 2001; 29: 308-319
    CrossrefPubMedSuche in Google Scholar
  • 35 Maurer JK, Parker RD, Jester JV. Extent of initial corneal injury as the mechanistic basis for ocular irritation: key findings and recommendations for the development of alternative assays. Regul Toxicol Pharmacol 2002; 36: 106-117
    CrossrefPubMedSuche in Google Scholar
  • 36 Meller D, Pauklin M, Westchempor H et al. Autologe kultivierte Limbusstammzelltransplantation. Ophthalmologe 2010; 107: 1133-1138
    CrossrefPubMedSuche in Google Scholar
  • 37 Merle H, Donnio A, Ayeboua L et al. Alkali ocular burns in Martinique (French West Indies) Evaluation of the use of an amphoteric solution as the rinsing product. Burns 2005; 31: 205-211
    CrossrefPubMedSuche in Google Scholar
  • 38 Midelfart A, Hagen YC, Myhre GB. Chemical burns to the eye. Tidsskr Nor Laegeforen 2004; 124: 49-51
    PubMedSuche in Google Scholar
  • 39 Mirza GE, Karaküçük S. A rare corneal injury caused by molten lead. Acta Ophthalmol (Copenh) 1993; 71: 573-574
    Suche in Google Scholar
  • 40 Miyamoto F, Sotozono C, Ikeda T et al. Retinal cytokine response in mouse alkali-burned eye. Ophthalmic Res 1998; 30: 168-171
    CrossrefPubMedSuche in Google Scholar
  • 41 Nicaeus T, Erb C, Rohrbach M et al. [An analysis of 148 outpatient treated occupational accidents]. Klin Monatsbl Augenheilkd 1996; 209: A7-A11
    Thieme ConnectPubMedSuche in Google Scholar
  • 42 Paysse EA, Hamill MB, Koch DD et al. Epithelial healing and ocular discomfort after photorefractive keratectomy in children. J Cataract Refract Surg 2003; 29: 478-481
    CrossrefPubMedSuche in Google Scholar
  • 43 Pellegrini G, Traverso CE, Franzi AT et al. Long-term restoration of damaged corneal surfaces with autologous cultivated corneal epithelium. Lancet 1997; 349 (9057) 990-993
    CrossrefPubMedSuche in Google Scholar
  • 44 Pelletier CR, Jordan DR. An unusual and severe thermal burn to the eye and adnexa. Can J Ophthalmol 1996; 31: 319-323
    PubMedSuche in Google Scholar
  • 45 Pfister RR, Haddox JL, Sommers CI et al. A neutrophil chemoattractant is released from cellular and extracellular components of the alkali-degraded cornea and blood. Invest Ophthalmol Vis Sci 1996; 37: 230-237
    PubMedSuche in Google Scholar
  • 46 Pirouzmanesh A, Herretes SP, Suwan-Apichon O et al. Use of topical human amniotic fluid in the treatment of acute alkali burns of the eye poster. ARVO Abstr 2722 Fort Lauderdale ARVO Meeting 2006.
  • 47 Pospisil H, Holzhutter HG. A compartment model to calculate time-dependent concentration profiles of topically applied chemical compounds in the anterior compartments of the rabbit eye. Altern Lab Anim 2001; 29: 347-365
    CrossrefPubMedSuche in Google Scholar
  • 48 Qazi K, Gerson LW, Christopher NC et al. Curling iron-related injuries presenting to U.S. emergency departments. Acad Emerg Med 2001; 8: 395-397
    CrossrefPubMedSuche in Google Scholar
  • 49 Reim M. Ein neues Behandlungskonzept für schwere Verätzungen und Verbrennungen des Auges. Fortschr Ophthalmol 1989; 86: 722-726
    PubMedSuche in Google Scholar
  • 50 Reim M. Ein neues Behandlungskonzept für schwere Verätzungen. Klin Monatsbl Augenheilkd 1990; 196: 1-5
    Thieme ConnectPubMedSuche in Google Scholar
  • 51 Reim M. [Surgical anatomy, physiology, biochemistry and questions on the inlay technique]. Ophthalmologe 1992; 89: 109-118
    PubMedSuche in Google Scholar
  • 52 Reim M. The results of ischaemia in chemical injuries. Eye 1992; 6 (Pt 4) 376-380
    CrossrefPubMedSuche in Google Scholar
  • 53 Reim M, Teping C. Surgical procedures in the treatment of most severe eye burns. Acta Opthalmol Suppl 1989; 67: 47-54
    Suche in Google Scholar
  • 54 Reim M, Bahrke C, Kuckelkorn R et al. Investigation of enzyme activities in severe burns of the anterior eye segment. Graefes Arch Clin Exp Ophthalmol 1993; 231: 308-312
    CrossrefPubMedSuche in Google Scholar
  • 55 Reim M, Kottek AA, Schrage NF. The cornea surface and wound healing. Prog Retin Eye Res 1997; 16: 183-225
    CrossrefSuche in Google Scholar
  • 56 Reim M, Redbrake C, Schrage N. Chemical and thermal injuries of the eyes. Surgical and medical treatment based on clinical and pathophysiological findings. Arch Soc Esp Oftalmol 2001; 76: 79-124
    PubMedSuche in Google Scholar
  • 57 Rihawi S, Frentz M, Schrage NF. Emergency treatment of eye burns: which rinsing solution should we choose?. Graefes Arch Clin Exp Ophthalmol 2005; 20: 1-10
    Suche in Google Scholar
  • 58 Rihawi S, Frentz M, Becker J et al. The consequences of delayed intervention when treating chemical eye burns. Graefes Arch Clin Exp Ophthalmol 2007; 10: 1507-1513
    Suche in Google Scholar
  • 59 Rihawi S, Frentz M, Reim M et al. Rinsing with isotonic saline solution for eye burns should be avoided. Burns 2008; 34: 1027-1032
    CrossrefPubMedSuche in Google Scholar
  • 60 Roper-Hall MJ. A retrospective study of eye injuries. Ophthalmologica 1969; 1–3: 12-27
    PubMedSuche in Google Scholar
  • 61 Schrage NF, Schloßmacher B, Aschenzheimer W et al. Phosphate buffer in alkal eye burns as an inducer of experimental corned calcification. Burns 2001; 27: 459-464
    CrossrefPubMedSuche in Google Scholar
  • 62 Schrage NF, Benz K, Beaujean P et al. A simple empirical calibration of energy dispersive X-ray analysis (EDXA) on the cornea. Scanning Microsc 1993; 7: 881-888
    PubMedSuche in Google Scholar
  • 63 Schrage NF, Flick S, Redbrake C et al. Electrolytes in the cornea: a therapeutic challenge. Graefes Arch Clin Exp Ophthalmol 1996; 234: 761-764
    CrossrefPubMedSuche in Google Scholar
  • 64 Schrage NF, Flick S, v. Fischern T et al. Temperaturveränderungen der Hornhaut unter verschiedenen Verbänden. Ophthalmologe 1997; 94: 492-495
    CrossrefPubMedSuche in Google Scholar
  • 65 Schrage NF, Schlossmacher B, Aschenbernner W et al. Phosphate buffer in alkali eye burns as an inducer of experimental corneal calcification. Burns 2001; 27: 459-464
    CrossrefPubMedSuche in Google Scholar
  • 66 Schrage NF, Rihawi R, Frentz M et al. [Acute therapy for eye burns]. Klin Monatsbl Augenheilkd 2004; 221: 253-261
    Thieme ConnectPubMedSuche in Google Scholar
  • 67 Schrage NF, Kompa S, Ballmann B et al. Relationship of eye burns with calcifications of the cornea?. Graefes Arch Clin Exp Ophthalmol 2005; 243: 780-784
    CrossrefPubMedSuche in Google Scholar
  • 68 Söderberg K, Kuusinen P, Mathieu L et al. Hexafluorine: an improved method for emergency decontamination of ocular and dermal hydrofluoric acid splashes. Vet Human Toxicol 2004; 46: 216-218
    Suche in Google Scholar
  • 69 Spöler F, Frentz M, Först M et al. Analysis of hydrofluoric acid penetration and decontamination of the eye by means of time-resolved optical coherence tomography. Burns 2008; 34: 549-555
    CrossrefPubMedSuche in Google Scholar
  • 70 Tseng SC, Prabhasawat P, Barton K et al. Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deciency. Arch Ophthalmol 1998; 116: 431-441
    CrossrefPubMedSuche in Google Scholar
  • 71 Tuppurainen K. Cryotherapy for eyelid and periocular basal cell carcinomas: outcome in 166 cases over an 8-year period. Graefes Arch Clin Exp Ophthalmol 1995; 233: 205-208
    CrossrefPubMedSuche in Google Scholar
  • 72 Vajpayee RB, Gupta NK, Angra SK et al. Contact thermal burns of the cornea. Can J Ophthalmol 1991; 26: 215-218
    PubMedSuche in Google Scholar
  • 73 Ventura AC, Böhnke M. Pentoxifylline influences the autocrine function of organ cultured donor corneas and enhances endothelial cell survival. Br J Ophthalmol 2001; 85: 1110-1114
    CrossrefPubMedSuche in Google Scholar
  • 74 von Fischern T, Lorenz U, Burchard WG et al. Changes in mineral composition of rabbit corneas after alkali burn. Graefes Arch Clin Exp Ophthalmol 1998; 236: 553-558
    CrossrefPubMedSuche in Google Scholar
  • 75 Watson SL, Geerling G, Dart JK. Clinical study of therapeutic ocular surface medium for persistent epithelial defect. Ophthalmic Res 2014; 51: 82-87
    CrossrefPubMedSuche in Google Scholar
  • 76 Watt BE, Proudfoot AT, Vale JA. Hydrogen peroxide poisoning. Toxicol Rev 2004; 23: 51-57
    CrossrefPubMedSuche in Google Scholar
  • 77 Wilbanks GA, Streilein JW. Fluids from immune privileged sites endow macrophages with the capacity to induce antigen-specific immune deviation via a mechanism involving transforming growth factor-beta. Eur J Immunol 1992; 22: 1031-1036
    CrossrefPubMedSuche in Google Scholar
  • 78 Wilson G. Effect of hydrogen peroxide on epithelial light-scattering and stromal deturgescence. CLAO J 1990; 16 (1 Suppl) S11-S14 discussion S14–S15
    PubMedSuche in Google Scholar
  • 79 Yamada J, Dana MR, Sotozono C et al. Local suppression of IL-1 by receptor antagonist in the rat model of corneal alkali injury. Exp Eye Res 2003; 76: 161-167
    CrossrefPubMedSuche in Google Scholar
  • 80 Yuen HK, Yeung BY, Wong TH et al. Descemet membrane detachment caused by hydrogen peroxide injury. Cornea 2004; 23: 409-411
    CrossrefPubMedSuche in Google Scholar