- •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 |
27 |
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pKa |
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NH |
33 NH - |
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3 |
2 |
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strong bases |
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Very weak acids |
doesn’t exist in water |
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no ionisation |
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C |
H |
OH |
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19 C |
H |
O− |
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2 |
5 |
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5 |
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H2O |
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14 |
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OH− |
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+ |
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NH |
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9.2 NH |
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4 |
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The strength of acids |
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The strength |
of bases |
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CH3CO2H |
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4.8 CH3CO2− |
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O+ |
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H |
O |
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H |
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0 |
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3 |
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HNO |
3 |
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−3 NO |
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strong acid |
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3 |
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Very weak bases |
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doesn’t exist in water |
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HCI |
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−7 CI– |
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without action on water |
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pK Scale
Fig. 3.39 Chemical reactivity of aqueous solutions
pH = 1/2 (pKa − log C) With C for Concentration of the acid or base.
Fig. 3.40 pH of a weak acid
pH = 7 + 1/2 (pKa + log C)
Fig. 3.41 pH of a weak base
pH = 1/2 (pKa - log C) = 1/2 (3.2 - log 0.1)
= 1/2 (3.2 + 1) = 2.1)
Fig. 3.42 pH of HF in a water solution
pH = 7 + 1/2 (pKa + log C) = 7 + 1/2 (9.2 + 0) = 11.6
Fig. 3.43 pH of 1N ammonia solution
pH = -log [C] for a strong acid and
pH = 14 + log [C] for a strong base
Fig. 3.44 pH of strong acid and base
In the following table, we shall find examples of acids, which illustrate, using the pKa value, their more or less important strength (Fig. 3.45).
3.2.4.2 Prediction of the Irritant
Power of Acids or Bases
Given the concentration and the pK of the involved corrosive substance, it is possible to predict if a solution of an acid or basic chemical is not aggressive or can be irritant or corrosive to the eye. So we define the notion of threshold concentration as developed below in Sect. 3.4.3.2.
The intermediate zone of the scale – pK between 5 and 9 – is considered as having no aggressive effect for the physiological balance of the cornea. Out of this zone, we can notice either an irritation when the substance is diluted or corrosion when the substance is concentrated.
Below 0.2N, there is no reaction of the tissues. In the intermediate cases, either with a limit pK in the intervals 5–4 and 9–10 or for weakly concentrated solutions (from 0.2 to 1N), there is only an irritation. Only the solutions with a pK lower than 4 or superior to 10 and a concentration of 1N or more are corrosive (Fig. 3.46).
3.2.4.3 Scales of Energy Level
It is easy to understand that every type of reactive chemical function causing an irritation or a corrosion corresponds to a type of elementary reaction (Sect. 3.2).
The intensity of reaction of the chemical aggressor can be represented on a scale of energy, the functioning of which is governed by a simple rule.
•Thus, in an acid–base solution, there is an exchange of protons and the relation is (Fig. 3.47). The reaction develops until equilibrium reaching a specific
pH. Acid1 reacts on base2 when pK1 < pK2. The reaction will move even more to the right side when pK1–pK2 is big.
•For oxidizing and reducing agents, the intrinsic potential E°, measured in volts (V) or millivolts (mV), is the expression of their reactivity and the general rule to apply is: “An oxidizing agent oxidizes every reducing agent with a weaker potential than its own.”
The applicable relation is (Fig. 3.48)
28 |
3 The Chemical Agents and the Involved Chemical Reactions |
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Acid |
Buffering base |
pKa |
HI (the strongest)
Hydriodic acid
H2SO4
Sulfuric acid
HBr
Hydrobromic acid
HCI
Hydrochloric acid
H3O+
Hydronium ion
CH3SO3H Methanesulfonic acid
HCIO3
Chloric acid
CI3C−COOH Trichloroacetic acid
H2CrO4
Chromic acid
H2N−SO2−OH
Sulfamic acid
HOOC−COOH
Oxalic acid
HOOC−CH=CH−COOH
Maleic acid
CICH2−COOH Dichloroacetic acid
I − |
−5.2 |
HSO4− |
−5.0 |
Br − |
−4.7 |
CI − |
−2.2 |
H2O |
0 |
CH3SO3− |
−1.2 |
HCIO3− |
0 |
CI3C−COO− |
0.66 |
HCrO4− |
0.8 |
H2N−SO2O− |
1.0 |
HOOC−COO− |
1.2 |
HOOC−CH=CH−COO− 2.0 |
|
CICH2−COOH |
2.87 |
Fig. 3.45 Acid strength and pK value
Acid |
Buffering base |
pKa |
HOOC−CH2−COOH Malonic acid
HF
Hydrofluoric acid
HOOC−CH=CH−COOH
Malic acid
HCOOH
Formic acid
H2C=CH−COOH
Acrylic acid
CH3COOH
Acetic acid
HCN
Hydrocyanic acid
C6H5−OH
Phenol
CH3SH
Methanethiol
CH3OH
Methanol
H2O
Water
NH3
Ammonia
H2 (the weakest)
HOOC−CH2−COO − |
2.9 |
F − |
3.2 |
HOOC−CH=CH−COO − |
3.4 |
HCOO − |
3.8 |
H2C=OH-COO − |
4.25 |
CH3COO − |
4.76 |
CN − |
9.2 |
C6H5−O − |
9.9 |
CH3S − |
10.0 |
CH3O − |
15.5 |
HO − |
14 |
H2N − |
35 |
H − |
38 |
