7.2.3  The Initial Sketch

All of the ocular clinical signs will be reported on a simple sketch including, at least:

•The extent of the conjunctival ischemia, the evaluation of which is essential for a probable secondary surgery treatment: the autograft of limbus. The accurate measurement of the conjunctival ischemia in the limbal zone is indeed important because the altered zones cannot supply stem cells whereas the superior zones without ischemia can be used as grounds for the sampling of stem cells. Measured in degrees, the extent of this safe region is also important to know if it can be used for its efficiency as a graft as well as to reduce the risk of lack of stem cells for the donor eye. This last point is the reason why a lot of authors limit the recommendation of autograft to unilateral burns and usually prefer the option of the graft of amniotic membrane.

•The ulcer of the cornea. Successive sketches show the evolution of the cicatrization of the epithelium, which is a centripetal phenomenon.

7.2.4  Other Initial Signs of Chemical

Eye Burn

The initial clinical examination of an eye burn can also reveal other signs of seriousness:

•Either signs of alteration of the conjunctiva

•Or signs of the intraocular lesions due to the penetration of the chemical into the eye. We shall remind that the penetration of a chemical into the eye is very fast and happens within the first minute after projection (See Sect. 5.16 and Fig. 5.12).

7.2.4.1  Signs of Alteration of the Conjunctiva

We have highlighted above the importance of the accurate evaluation of the zone of conjunctival ischemia on the limbal part because of the probable later necessity of sampling the safe zone.

The evaluation of the conjunctival hurts on the conjunctival zone is also important. Thus, the conjunctival

ulcer must be measured like the corneal ulcer which reacts with fluorescein. In general, the conjunctival ulcer corresponds to the zone of ischemia. But the conjunctival ischemia may alter zones with no conjunctival ulcer.

In chemical eye burns, there is always a fast enough conjunctival cicatrization but it may generate some symblepharons. Symblepharons are adherences that develop between the eyelids and the eyeball. They may cause a reduction of the mobility of both eye and eyelids. They are the result of between the bulbar conjunctiva and the palpebral conjunctiva sticking to each other after the cicatrization of the bulbar and palpebral conjunctival ulcers facing each other. It is then necessary to examine with meticulous care the entire surface of the conjunctiva including the conjunctival sacs. Because of the bulbar and palpebral conjunctival ulcers, the prevention of later adherences requires the placement of antisymblepharon rings.

At last, the examination of an eye burn patient aims to search and eliminate any concretion, particularly at the level of the conjunctival sacs. These concretions may help a continuation of the burn, because they are due to precipitations of either the chemical (for instance, lime) or dust projected with the chemical. These concretions result in the gradual decomposition of the compound at the level of the eye.

7.2.4.2  Signs of Intraocular Lesions

When the burn is serious, the initial examination may reveal:

•A Tyndall effect in the anterior chamber. The presence of an intraocular inflammation is a bad prognosis

•The presence of pigments on the inner side of the cornea. Released by the iris, these pigments reveal a high concentration of chemical in the anterior chamber. Except in some very rare cases, such burns result in eye atrophy

•A cataract

But all of these signs also show that the eye reacts to the burn. Actually, they may also appear in a secondary time.

At last, the clinical examination of the eye also requires a measurement of the ocular pressure. The corneal ulcer makes this measurement using an