References and Further Reading

American Association of Poison Control Centers Toxic Exposure Surveillance­ System database, 2002–2005, Human ocular exposures by substance. Data pull 8/23/06.

Brahma AK, Inkster C. Alkaline chemical ocular injury from Emla cream. Eye 9(Pt 5): 658–659, 1995.

Brodovsky SC, McCarty CA, Snibson G, et al. Management of alkali burns: an 11-year retrospective review. Ophthalmology 107: 1829–1835, 2000.

Corazza M, Trincone S, Virgili A. Effects of airbag deployment: lesions, epidemiology,­ and management. Am J Clin Dermatol 5: 295–300, 2004.

Davis AR, Ali QK, Aclimnados WA, Hunter PA. Topical steroid use in the treatment of ocular alkali burns. Br J Ophthalmol 81: 732–734, 1997.

He J, Bazan NG, Bazan HE. Alkali-induced corneal stromal melting prevention­ by a novel platelet-activating factor receptor antagonist. Arch Ophthalmol 124: 70–78, 2006.

Ikeda N, Hayasaka S, Hayasaka Y, Watanabe K. Alkali burns of the eye: effect of immediate copious irrigation with tap water on their severity. Ophthalmologica 220: 225–228, 2006.

Kompa S, Schareck B, Tympner J, et al. Comparison of emergency eye-wash products in burned porcine eyes. Graefes Arch Clin Exp Ophthalmol 240: 308–313, 2002.

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

Laria C, Alio JL, Ruiz-Moreno JM. Combined non-steroidal therapy in experimental corneal injury. Ophthalmic Res 29: 145–153, 1997.

Merle H, Donnio A, Ayeboua L, et al. Alkali ocular burns in Martinique (French West Indies). Evaluation of the use of an amphoteric solution as the rinsing product. Burns 31: 205–211, 2005.

Schrage NF, Kompa S, Haller W, Langefeld S. Use of an amphoteric lavage solution for emergency treatment of eye burns. First animal type experimental­ clinical considerations. Burns 28: 782–786, 2002.

Sekundo W, Augustin AJ, Strempel I. Topical allopurinol or corticosteroids and acetylcysteine in the early treatment of experimental corneal alkali burns: a pilot study. Eur J Ophthalmol 12: 366–372, 2002.

Wagoner MD. Chemical injuries of the eye: current concepts in pathophysiology­ and therapy. Surv Ophthalmol 41: 275–313, 1997.

Wagoner MD, Kenyon KR. Chemical injuries of the eye. In: Albert DM, Jacobiec FA, eds Principles and Practice of Ophthalmology, 2nd edn. WB Saunders, Philadelphia, 2000.

Clinical significance

Boric acid dust has been reported as an ocular irritant in industrial exposures although it is generally considered non-toxic to the eyes. In low concentrations, it has historically been used as an eye wash. In a private data pull, the American Association of Poison Control Centers Toxic Exposure Surveillance System database recorded a low incidence of ocular injury from 2001–2005, but there were two reports of ocular injury rated as ‘major’ (indicating some type of significant residual disability) and 10 reports of injury rated as ‘moderate’ (indicating an injury with prolonged symptoms requiring treatment but not resulting in permanent injury). However, this data does not detail the nature of the injuries reported or their treatment.

Recommendations

Standard irrigation with sterile water or isotonic saline is recommended for ocular exposure to boric acid dust. As boric acid and borax are usually present in the form of soaps and cleansers, most exposures to these substances will coincide with exposures to surfactants. See the section on surfactants for how to treat these injuries.

References and Further Reading

American Association of Poison Control Centers Toxic Exposure ­Surveillance System database, 2002–2005, human ocular exposures by substance. Data pull 8/23/06.

Garabrant DH, Bernstein L, Peters JM, Smith TJ. Respiratory and eye irritation from boron oxide and boric acid dusts. J Occup Med 26: 585–6. 1984.

Generic name: Chlorine

Synonyms: Bleach, chlorine gas, sodium hypochlorite, calcium hypochlorite; hypochlorous acid, chloramines, chlorinated isocyanurates, chlorinated hydantoins, chlorinated lime, chlorine dioxide, tosylchloramide sodium, sodium oxychloride.

Proprietary names/products containing: Found in

a variety of household and commercial cleaners.

Class: Bleaches

Generic name: Boric acid.

Synonyms: Orthoboric acid; boracic acid.

Proprietary names/products containing: In a vari-

ety of household laundry detergents, hand soaps and lotions.

Primary use

Borax (or sodium tetraborate) is a naturally occurring alkaline compound that is a precursor in the manufacture of boric acid. Used as a preservative, buffer, antiseptic and fungicide, boric acid is also used to manufacture glazes and enamels, and to fireproof textiles and wood. In the household, boric acid and borates as tablets or powder are used to kill insects. It is a frequent ingredient in soaps and detergents. It is used in conjunction with borax to buffer and preserve certain eye drops.

Ocular side effects

Topical ocular exposure

Certain

1. Irritation

Primary use

A halogen gas, chlorine is also available as a pressurized solution. There are many more stable compounds that release chlorine in the form of hypochlorous acid and hypochlorite ion when exposed­ to water. When otherwise stable chlorine-releasing compounds are combined with acids, chlorine gas may be liberated, and when combined with ammonia, poisonous chloramines may be released.

The ability of chlorine gas or the non-ionized hypochlorous acid molecule to chlorinate proteins yields its extreme effectiveness in disinfection. Chlorine gas is used to sanitize public ­water supplies. Various chlorine compounds are used to disinfect swimming pools. In medical clinics, bleach (sodium hypochlorite 5-10%) is commonly used as a surface disinfectant, including the disinfection of applanation tonometer tips.

Ocular side effects

Topical ocular exposure

Certain

1. Irritation

2. Cornea

a.Edema

b.Punctate epithelial erosions 3. Conjunctiva – hyperemia