Rinsing Therapy of Eye Burns

Rinsing is the most outstanding early measure to set up in order to prevent further propagation of the corrosive to the eye and to remove the later on disasterproducing inflammatory proteins and mediators in the clinical course of treatments with a lower frequency. This is a well-known and trained fact in all official recommendations all over the world concerning first aid in eye burns (ANSI Standards and Recommen­ dations of the Berufsgenossenschaften in Germany). Cleaning with any watery fluid of pH below 9 and over 5, with temperature limits between 10 to 42°C, seems in first line to be acceptable if no other specified fluids are available. The most outstanding treatment factor, except from the fluid, is the time of intervention [1]. If early treatment is done within the first seconds, the decontamination can be completed before the immersion of the tissue, and the disaster of severe burns requires real intratissular decontamination strategies [2] to prevent intraocular burns [3]. There are basic considerations on type, action, and composition of fluids that are demonstrated in the following subchapters­.

This was not a subject of systematic research except the approval that phosphate buffer was preferred due to data of the 1970s from Laux [4]. Up to now, there is only one scientific prove out of chemical neutralization experiments on borate buffer, phosphate buffer, or Diphoterine® in the beaker [5]. In clinical context, there is only one systematic study of Merle and Gerard who

N. Schrage 

Head of the Department Professorship at the RWTH Aachen, Foundator of ACTO (Aachen Center of Technology Transfer in Ophthalmology), Department of Ophthalmology of the City Hospital, Augenklinik Köln Merheim, Cologne, Germany e-mail: schrage@acto.de

performed a prospective study comparing saline solution and rinsing with Diphoterine® in a clinical trial [6].

6.1  Important

To have a precise scientific insight into the action of rinsing fluids, we have to be aware of the mechanisms involved, which are:

•Dilution

•Diffusion

•Chemical reaction

•Osmolar regulation of the tissues

•Remnants from any chemical process

To elucidate this, for example, the eye burn with 2M sodium hydroxide is known to change osmolarity (1,800 mOsmol/kg) and propagates by diffusion into the tissue (See OCT images at Sect. 5.1.6 and Fig. 5.12). Spreading into the tissue results in immediate saponification of the cellular membranes and lysis of collagen to gelatin and low molecular breakdown products that have been ­identified by Pfister to be the origin of proinflammatory responses [7]. Furthermore, we have shown in the experimental part of Chap. 5 (See Sect. 5.2.6 and Figs. 5.16 and 5.17) that the release of mediators is the origin of the additional biological response.

To have insight into these mechanisms, we have performed and published several experiments on diffusion of corrosive, rinsing with different osmolar solutions to check the influence of osmolar conditioning of the cornea [8]. Further, we have tried to evaluate the diffusion of corrosive throughout the cornea [9]. In the latest experiments being published under www.acto.de, we present the effect of fluids of different osmolarities and their action on cells. Unpublished data give insight into