Third World Eye Care

[LaurieB]

Hello!

I am writing to get your opinion on a situation a friend of mine is in. He is an American doing humanitarian work in Cambodia and recently got splashed with Drano in his right eye. He has recieved treatment in Cambodia, but become blind in that eye. Would he have any chance of recovering sight if he were to be treated by an American or similarly trained specialist? He is not inclined to pursue treatment, and I am trying to gauge whether it would be worthwhile for me to convince him otherwise.

Thanks in advance for your insights and recommendations!
Laurie

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[Andrew_Doan]

Drano is an alkali, and alkali injuries are the worst type of chemical injury. Initial treatment requires irrigation with normal saline to neutralize the pH to ~7. Depending on the degree of injury, patients may require: oral Vitamin C, oral doxycycline, steroid drops, antibiotic drops, citrate drops, and lubricants. Increased eye pressure should also be treated as needed. If the injury is now old, and there was extensive injury to the corneal limbus, then his cornea may fail. He may require a corneal transplant. If a transplant is needed, then he should come to the US for the surgery and post-operative care.

 

[Richard_Hom]

Drano is an alkali, and alkali injuries are the worst type of chemical injury. Initial treatment requires irrigation with normal saline to neutralize the pH to ~7. Depending on the degree of injury, patients may require: oral Vitamin C, oral doxycycline, steroid drops, antibiotic drops, citrate drops, and lubricants. Increased eye pressure should also be treated as needed. If the injury is now old, and there was extensive injury to the corneal limbus, then his cornea may fail. He may require a corneal transplant. If a transplant is needed, then he should come to the US for the surgery and post-operative care.

Dr. Doan,

If the bed to the limbus is suboptimal, will a limbal stem cell transplant be of benefit? What other ways to rehabilitate the bed for a successful PKP?

Richard

 

[Andrew_Doan]

Dr. Doan,

If the bed to the limbus is suboptimal, will a limbal stem cell transplant be of benefit? What other ways to rehabilitate the bed for a successful PKP?

Richard

I'm not familiar of any special ways to rehabilitate the bed for PKP. Perhaps someone with more experience can comment on this.

In regards to a limbal stem cell transplant, this may be of benefit to the new graft if the patient's limbus is suboptimal.

 

[Richard_Hom]

I'm not familiar of any special ways to rehabilitate the bed for PKP. Perhaps someone with more experience can comment on this.

In regards to a limbal stem cell transplant, this may be of benefit to the new graft if the patient's limbus is suboptimal.

Dr. Doan,

Thanks.

Additionally, what is the incidence, if there is any such study, of corneal perforation? Secondary endophtalmitis?

Thanks,
Richard

 

[LaurieB]

Dr. Doan,

Thanks for your input. If I understand you correctly, my friend could benefit from a corneal transplant. Is damage to his corneal limbus the source of his blindness? His injury occured about a month ago so any treatment would be for long-term vision repair.

I'll pass this information along and see if he can be persuaded to pursue treatment.

Thanks again for the information!
Laurie

 

[Richard_Hom]

Dr. Doan,

Thanks for your input. If I understand you correctly, my friend could benefit from a corneal transplant. Is damage to his corneal limbus be the source of his blindness? His injury occured about a month ago so any treatment would be for long-term vision repair.

I'll pass this information along and see if he can be persuaded to pursue treatment.

Thanks again for the information!
Laurie

LaurelB,

Just a point of further clarification. The limbus is the outer edge of the cornea and doesn't have a part in passing light through to the retina.

Damage to the cornea centrally is causing his poor vision. Damage "out to the limbus" will determine the prognosis of PKP or the type of surgical procedure needed.

Richard

 

[LaurieB]

Richard,

Thank you for the clarification!

Laurie

 

[Retinamark]

Hello!

I am writing to get your opinion on a situation a friend of mine is in. He is an American doing humanitarian work in Cambodia and recently got splashed with Drano in his right eye. He has recieved treatment in Cambodia, but become blind in that eye. Would he have any chance of recovering sight if he were to be treated by an American or similarly trained specialist? He is not inclined to pursue treatment, and I am trying to gauge whether it would be worthwhile for me to convince him otherwise.

Thanks in advance for your insights and recommendations!
Laurie

It depends how long since the injury & what you mean by blind. The vision may improve in the first few weeks, but if the vision has been bad for months, it's very unlikely to spontaneously improve. If he is truly totally / NPL blind, then he must have damaged more than just the cornea. Severe alkali burns can cause cataract & terrible glaucoma as well. If he can still count fingers or read the big letters on the chart, then maybe it is just the cornea. As others mentioned, the most important factor is the status of his limbal stem cells & how many clock hours he's lost. If you lose all of your stem cells, a corneal transplant will temporarily clear his vision, but it will be destined to fail. (It's a cruel teaes in a way to give someone their sight back, only for them to rapidly lose it again).
If it is a unilateral injury & his other eye is normal, then autologous limbal stem cell transplants would offer an increased chance of success. Cadaveric limbal stem cell transplants are much more controversial bc of a high failure rate & need for systemic immunosuppression.

We are still many years away from a successful keratoprosthesis. They've developed one of the better ones in Perth, but it still is a last resort & wouldn't offer your friend much extra useful vision if his other eye is normal.

If he is in Cambodia, another much closer alternative would be to see Prof Lawrence Hirst at the University of Queensland in Brisbane. He's a world class corneal specialist (trained at the Royal Victorian Eye & Ear in Melbourne & then spent many years on the staff at the Wilmer / Johns Hopkins in Baltimore. )

Good luck

 

[Visionary]

LaurieB-

Another consideration is the degree of scarring. In some cases of severe chemical injury to the cornea, transplant may only correct vision transiently, for the scar tissue eventually expands to obscure the transplant. One of the more promising approaches I've heard about in these cases is the use of temporary amniotic tissue grafts to prevent regrowth of scar tissue following its excision. This results in improved transplant outcomes. Dr. Ming Wang (Wang Vision Institute, Nashville, TN) pioneered this research and has used it successfully on a number of severe chemical injury cases.

Of course, as indicated by the previous posts, the particular approach required for your friend will depend upon the extent of damage.