- •List of Authors
- •Foreword
- •Preface
- •1.1 Burns for Doctors in Antiquity
- •1.1.1 Chemical Burns Since Antiquity
- •1.1.4 Conclusion
- •1.2 Modern History of the Chemical Burns
- •1.2.2 Start of Medical Treatment
- •1.2.4 Rinsing Therapy
- •1.2.5 Classification of Eye Burns
- •1.2.6 Specific Treatment Options
- •References
- •2.1 Introduction
- •2.2.1 Individual Publications/Case Series
- •2.2.3 US Bureau of Labor Statistics Data
- •2.3 Etiology
- •2.3.1 Work-Related Injury
- •2.3.2 Deliberate Chemical Assault
- •2.3.3 Complications of Face Peeling
- •2.3.4 Burn Center/Hospital Studies
- •2.4 Involved Chemicals
- •2.5 Conclusions
- •References
- •3.1 From Chemistry to Symptoms
- •3.1.1 What Is a Chemical Burn?
- •3.1.3 Extent of the Matter
- •3.2 The Chemical Agent
- •3.2.2.1 Acidic Function
- •3.2.2.2 Basic Function
- •3.2.2.3 Oxidizing Function
- •3.2.2.4 Reduction Function
- •3.2.2.5 Solvent Function
- •3.2.2.6 Chelating Function or Complexation
- •Energy Scale of Chelation Reactions
- •3.2.2.7 Alkylation Reaction
- •Reactivity Scale for Alkylating Agents
- •3.2.3 Modulation of the Expression of the Reactivity of a Molecule
- •3.2.3.1 Acetic Acid and Its Derivatives
- •3.2.3.2 Hydrofluoric Acid
- •3.2.3.3 Phenol
- •3.2.3.4 Methylamines Series
- •3.2.3.5 Last Illustration: Acrolein
- •3.2.4.1 Acid–Base Scale
- •3.2.4.3 Scales of Energy Level
- •3.3 Constituents of the Tissues: Which Are the Biological and Biochemical Targets?
- •3.4 The Mechanisms of the Chemical Burn During the Contact Between the Aggressor and the Eye
- •3.4.3 Key Parameters of Chemical Burns
- •Solid Form
- •Viscosity
- •Exothermic Reaction
- •Titanium Tetrachloride
- •Trichloromethylsilane
- •Boron Trifluoride
- •Sulfuric Acid
- •Concentration of the Chemical
- •Phenomenon of the Diffusion of Corrosives in Relation with Their Concentration
- •Time of Contact
- •Temperature
- •Pressure
- •3.5 Practical Conclusions in Order to Manage the Optimal Chemical Decontamination of an Eye
- •3.5.2 Consequences of a Passive Washing: A Longer Time of Action
- •3.5.3 The Concept of Active Wash
- •3.6 What is Now the Extent of Our Knowledge About Ocular Chemical Burns?
- •References
- •4: Histology and Physiology of the Cornea
- •4.1 Corneal Functions
- •4.2 Anatomy Reminder
- •4.3 Histology
- •4.3.1 The Epithelium and Its Basement Membrane
- •4.3.1.1 The Lacrymal Secretion
- •4.3.1.2 The Corneal Epithelium
- •4.3.1.3 The Superficial Cells
- •4.3.1.4 The Intermediate Cells
- •4.3.1.5 Basal Cells
- •4.3.1.6 The Basement Membrane
- •4.3.2 Bowman’s Membrane
- •4.3.3 The Stroma
- •4.3.3.1 Keratocytes
- •4.3.3.2 The Collagen Lamellae
- •4.3.3.3 Ground Substance
- •4.3.3.4 Other Cells
- •4.3.4 Descemet’s Membrane
- •4.3.5 The Endothelium
- •4.3.6 The Limbus
- •4.4 Vascularization
- •4.5 Innervation
- •4.6 Factors of the Corneal Transparency
- •4.6.1 The Collagen Structure
- •4.6.2 The Proteoglycans Function
- •4.6.3 The Absence of Vascularization
- •4.6.4 The Scarcity of Cells in the Stroma
- •4.6.5 The Regulation of the Hydration
- •4.6.6.1 The Limbus
- •4.6.6.2 The Stroma
- •4.6.7 Action of the Intraocular Pressure
- •References
- •5.1 Physiology of the Cornea
- •5.1.1 Eye Burns Physiological Barriers
- •5.1.3 Physiology of Local Decontamination
- •5.1.5 Limits between Irritation and Burn
- •5.1.6 Eye Burns
- •5.2 Pathophysiology of Eye Burns1
- •5.2.1 Types of Burns and Eye Irritation
- •5.2.2 Mechanisms of Corneal Burns
- •5.2.2.1 Contact Mechanisms
- •5.2.2.2 Thermal Contact
- •Particles
- •Hot Fluids
- •Steam
- •Liquid Metals
- •Cold Gazes
- •5.2.2.3 Eye Burns with Chemically Active Foreign Bodies
- •5.2.2.4 Eye Burns with Chemically Reactive Fluids
- •Alkali
- •Acids
- •Peroxides
- •Hydrofluoric Acid
- •Detergents/Solvents
- •5.2.3 Influence of Osmolarity
- •5.2.4 Penetration Characteristics
- •5.2.5 Cellular Survival
- •5.2.6 Release of Inflammatory Mediators
- •References
- •6: Rinsing Therapy of Eye Burns
- •6.1 Important
- •6.3 Osmolar Effects in Rinsing Therapy
- •6.3.1 Types of Irrigation Fluids
- •6.4 Effect of Irrigation Fluids
- •6.5 High End Decontamination
- •6.5.2 Hydrofluoric Acid Decontamination
- •6.6 Side Effects of Rinsing Solutions in the Treatment of Eye Burns
- •6.7 Our Expectations
- •References
- •7: The Clinical of Ocular Burns
- •7.1 Few Reminders
- •7.1.1 Anatomy Reminder
- •7.1.2 Physiology Reminder
- •7.2.1.2 Ulcer of the Cornea
- •7.2.1.3 Edema of the Cornea
- •7.2.3 The Initial Sketch
- •7.2.4.1 Signs of Alteration of the Conjunctiva
- •7.2.4.2 Signs of Intraocular Lesions
- •7.2.4.3 Extraocular Signs
- •7.3 Clinical Examination of the Evolution of Chemical Eye Burns
- •7.3.1 Benign Ocular Burns
- •7.3.2 Serious Ocular Burns
- •7.3.2.1 Complications on the Ocular Surface
- •Corneal Nonhealing
- •Other Complications on the Ocular Surface
- •7.3.2.2 Endocular Complication
- •Bibliography
- •8: Surgical Therapeutic of Ocular Burns
- •8.1 Surgical Treatment of Ocular Burns
- •8.1.3 Tenon’s Plastics
- •8.1.4 The Conjunctival Transplantation
- •8.1.6 The Transplantation of Limbus
- •8.1.6.1 Exeresis of the Conjunctival Pannus
- •8.1.6.2 The Limbus Autograft
- •8.1.6.3 The Limbus Allograft
- •8.1.8 Keratoplasties
- •8.1.8.1 Big Diameter Transfixion Keratoplasty
- •8.1.8.3 The Deep Lamellar Keratoplasty
- •8.1.8.4 The Big Diameter Lamellar Keratoplasty
- •8.1.8.5 The Keratoplasty with Architectonic Goal
- •8.1.10 Keratoprosthesis
- •8.2 Surgical Treatment of Eyelid Burns
- •8.3 Conclusion
- •References
- •9: Emergency Treatment
- •9.3.1 In Occupational Environments
- •9.3.3 Industrial Accidents
- •9.3.4 Attacks
- •9.3.5 Lack of Initial Care
- •9.4 Organizing the Emergency Chain
- •9.5.1 Emergency Chain Definition
- •9.5.2 Safety Obligations
- •9.6 Which Care Chain for Optimum Management of Chemical Eye Burns?
- •9.6.1 Immediate Care by “Nonspecialists”
- •9.6.3.1 Develop a Protocol Which Must Be Simple in Every Aspect
- •9.6.3.2 Training
- •9.6.3.3 Necessary Specialized Supervision
- •Index
3.2 The Chemical Agent |
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O |
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O |
O |
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H |
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C |
H3C |
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C |
H3C CH2 CH2 C |
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O |
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H |
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O H |
O |
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H |
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Formic acid |
Ethanoïc acid |
Propanoïc acid |
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Fig. 3.2 Organic structure of corrosive agents
An irritant or a corrosive agent is, most of the times:
•A simple mineral entity: HCl, HF, HNO3, H2O2, H2SO4, NaOH, KOH, etc.
•An organic structure with a low molecular weight, based on a carbonated structure, for instance, formic acid, acetic acid, or propanoic acid (Fig. 3.2), etc.
Thus, the irritant and corrosive agents can be easily considered as molecular entities. In most cases, they are small or even very small structures (like hydrofluoric acid – HF, for instance).
3.2.2 Reactive Functional Groups
of Irritant or Corrosive Agents
In a simplistic vision, molecular structures have one or, more scarcely, several functional groups. These groups, of diverse nature, provide the expression of the reactivity of a molecule. They are functions such as:
3.2.2.1 Acidic Function
H+ results either from mineral acids or from carboxylic acids (–COOH function) or from alcohol function (–OH) or thiol function (–SH) (Fig. 3.3).
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OH |
OH |
O |
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H3C C |
O S O |
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OH |
OH |
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Ethanoic acid |
Sulfuric acid |
Phenol |
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NH2 |
Na |
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OH |
NH3 |
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Sodium hydroxide |
Azane |
Aniline |
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(Ammoniac) |
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Fig. 3.4 Examples of basic molecules
3.2.2.2 Basic Function
The basic function defines the substances called bases. Either mineral or organic, these substances have the following properties:
•To release an OH− ion
•The ability to capture a proton (H+ ion), for instance,
an amine group (–NH2), or a function including a triple bond: ≡N (Fig. 3.4)
Energy Scale of Acid–Base Reactions:The pK Notion
When an acid dissolves in water, a certain proportion of the molecule dissociates:
AH ® A- + H+
For any given molecule, the dissociated fraction in water is always equal. It is an intrinsic property of the molecule in relation with the connection forces between its constitutive atoms in water.
This constant is called Ka. The bigger the Ka constant, the bigger the dissociated fraction and the stronger the acidity.
Ka =[A-] ´[H+ ] / [AH]
The same reasoning works for the dissociation of bases with a constant of basicity called Kb. To make things easier, it is the logarithmic value of K, called pK, that is commonly used: pKa = –log10 Ka.
3.2.2.3 Oxidizing Function
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Some reagents can capture one or several electrons |
Fig. 3.3 Examples of acidic molecules |
and be part of an oxidation reaction. They are called |
20 |
3 The Chemical Agents and the Involved Chemical Reactions |
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O |
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O |
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C |
OH |
O |
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O |
− |
K |
+ |
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Cl |
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H3C |
O |
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Peracetic acid |
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O |
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Potassium perchlorate |
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Fig. 3.5 Examples of oxidizing function
oxidizers. They are either mineral, like KMnO4 or CrO3, or organic, like peracids (Fig. 3.5).
3.2.2.4 Reduction Function
Some reagents can release one or several electrons and be part of a reduction reaction. They are called reducing agents. Reducing agents are mineral, like Li, Na, or AlLiH4, or organic, like hydrazine (Fig. 3.6).
The redox potential is the energy scale of the redox reaction. It evaluates the importance of the oxidizing or the reducing property. Pure water is taken as a reference. Therefore, the value of the redox couple of water is said to be zero.
H2N NH2
Hydrazine
Fig. 3.6 Example of reduction function
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H |
CH2 CH2 CH2 CH3 |
H |
H |
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H3C CH2 CH2 CH2 |
H |
H |
Octane |
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H |
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Benzene |
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CI |
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CI C CI
CI
Carbon tetrachloride
Fig. 3.7 Examples of apolar solvents
H |
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H O |
H3C CH2 OH |
Water |
Ethanol |
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Fig. 3.8 Examples of protic polar solvents
3.2.2.5 Solvent Function
The solvation expresses according to a set of physicochemical characteristics. We distinguish several big families of solvents with varied structures or varied functional groups [6]:
•Apolar solvents, hydrocarbonated structure that are electronically symmetric molecules (Fig. 3.7).
•Protic polar solvents, like water – omnipresent in the body – or functions such as alcohol (–OH) or thiol (–SH) (Fig. 3.8). A molecule is said to be protic when it can release a proton. The connection between the hydrogen and another atom is weak enough. A molecule that cannot release a proton is
called aprotic. A molecule is said to be polar when, without any electronic field, the center of gravity of the negative charges is different from the center of gravity of the positive charges.
•Aprotic polar solvents, with functions such as ketone
(>C=O), nitrile (–CN), amide (O=C–NH2), sulfoxide (>S=O), ether (–O–), and halogenated and electronically asymmetric solvents (Figs. 3.9 and 3.10).
The partition coefficient of solvents is also a reactional energy scale.
A substance has more or less of affinity and it thus dissolves more easily in a type of solvent than in the other one. We call partition coefficient the constant
H3C |
CH3 |
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O |
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O |
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H3C CH2 |
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C |
CH3 |
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C |
H3C C |
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N |
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S |
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O |
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H |
N |
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Acetonitrile |
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H3C |
CH3 |
H3C CH2 |
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O |
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CH3 |
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Acetone |
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Dimethylsulfoxide |
Diethylether |
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Dimethylformamide |
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Propan-2-one
Fig. 3.9 Examples of aprotic polar solvents
