ring and/or by releasing them by passing a swab twice a day into the conjunctival sacs. The secondary treatment of symblepharons is far more complex and requires the techniques of reconstruction of the conjunctival sacs via a graft of mouth mucous membrane.

•Ectropium-trichiasis of the burnt eyelids, which very often develops simultaneously with symblepharons and causes a chronic irritation of the ocular surface that may result in some relapsing local infections. This entropium-trichiasis must be treated by surgical techniques including an eversion of the tarsus, associated with an exeresis of the eyelid margin at once as well as an exeresis of the adjacent conjunctiva wearing the ciliated folliculi with trichiasis and suture of a graft of mouth mucous membrane.

−−Healing of the cornea with the following potential consequences:

−−Persistent corneal edema, limiting the visual acuity and mainly reserving the long-term functional, even anatomical, prognosis of this burned eye

−−Cornealleucoma:opaqueandwhitescar(Fig.7.16) often with an irregular astigmatism and limited visual acuity of this eye

−−Frosted cornea having lost its transparency with, often associated, irregularity of its surface and the peripheral neovessels

7.3.2.2  Endocular Complication

Endocular complications occur in case of a serious burn. They aggravate the already very reserved prognosis of these burns. They may be associated with each

other with no preference and may be the following ones:

•Ocular hypertonia, which reveals either a direct lesion of the trabeculum by the chemical, or an inflammatory, reaction due to the burn. Hypertonia usually occurs during the second or third week following the burn. It must be recognized and treated by a topical treatment and a general hypotonizing therapy. It causes or aggravates the corneal edema, which is a limiting factor of the back growth of the corneal epithelium.

•Endocular inflammation. These inflammations usually generate synechia of the iris with the lens, which must be prevented by the instillation of mydriatic and cycloplegic collyrium.

•Cataract: opacity of the lens. It is sometimes visible from the initial examination but, more often, it appears secondarily. It is the consequence of the intensity and the depth of the ocular lesions. It is an element revealing a very bad final prognosis for the burned eye.

•Atrophy of the eye, ultimate evolution, usual and delayed (in the months that follow the accident) for serious chemical eye burns. This eye is obviously no more functional (absence of light perception). It is then necessary, in aesthetic purposes, to make an eviceration or an enucleation (ablation of the contents of the eye or its totality) allowing the implementation of an eye prosthesis. It is then the anatomical loss of the globe.

This chapter is based on the personal experience of the author already published, partially, in articles listed in the bibliography.

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Gérard, M., Merle, H., Domenjôd, M., Ayeboua, L., Richer, R., Jallot Sainte Rose, N.: Brûlures oculaires par bases. A propos de 6 cas. Ophtalmologie 10, 413–417 (1996)

Gérard, M., Merle, H., Chiambaretta, F., Louis, V., Richer, R., Rigal, D.: Technique chirurgicale de l’autotransplantation limbique dans les brûlures oculaires graves récentes. J Fr Ophtalmol 22(4), 502–506 (1999a)

Gérard, M., Merle, H., Ayeboua, L., Richer, R.: Etude prospective de 3 ans des brûlures oculaires par bases au C.H.U. de Fort de France. J Fr Ophtalmol 22(8), 834–847 (1999b)

Gérard, M., Louis, V., Merle, H., Josset, P., Menerath, J.M., Blomet, J.: Etude expérimentale sur la pénétration intraoculaire de l’ammoniaque. J Fr Ophtalmol 22(10), 1047– 1053 (1999c)

Gérard, M., Josset, P., Louis, V., Menerath, J.M., Blomet, J., Merle, H.: Existe-il un délai pour le lavage oculaire externe dans le traitement d’une brûlure oculaire par l’ammoniaque. Comparaison de deux solutions de lavage: sérum physiologique et Diphotérine®. J Fr Ophtalmol 23(5), 449–458 (2000)

Gérard, M., Merle, H., Chiambaretta, F., Rigal, D., Schrage, N.: An amphoteric rinse used in the emergency treatment of a serious ocular burn. Burns 28(7), 670–673 (2002)

Hugues Jr., W.F.: Alkali burns of the eye. Review of literature and summary of present knowledge. Arch Ophthalmol 35, 423–449 (1946a)

Hugues Jr., W.F.: Alkali burns of the eye. Clinical and pathological course. Arch Ophthalmol 36, 189–214 (1946b)

Kuckelkorn, R., Schrage, N., Keller, G., Redbrake, C.: Emergency treatment of chemical and thermal eye burns. Acta Ophthalmol Scand 80(1), 4–10 (2002)

Lagoutte, F.: Traumatismes et brûlures. In: Rigal, D. (ed.) L’épithélium cornéen. Rapport de la Société Française d’Ophtalmologie, pp. 210–214. Masson, Paris (1993)

Merle, H., Donnio, A., Ayeboua, L., Michel, F., Thomas, F., Ketterle, J., Leonard, C., Josset, P., Gérard, M.: Alkali ocular burns in Martinique (French West Indies). Evaluation of the use of an amphoteric solution as the rinsing product. Burns 31(2), 205–211 (2005)

Pouliquen, Y., Petroutsos, G.: Brûlures oculaires. In: Encycl. Méd. Chir. Ophthalmologie. Editions techniques. Paris, 21700 C10 (1983)

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Tseng, S.C.G.: Concept and applications of limbal stem cells. Eye 3(2), 141–157 (1989)

Wagoner, M.D., Kenyon, K.R.: Chemical injuries. In: Shingleton, B.J., Hersh, P.S., Kenyon, K.R., Topping, T.M., Woog, J.J. (eds.) Eye Trauma, pp. 107–114. Mosby, St Louis (1991)