Chemical burn caused by goof off?

[bgrayson]

Hi, I own a small cleaning company in Ocean City, MD. One of my employees was sprayed in the eyes indirectly by another employee. The victim was treated imediatly and worked for two more days, then went on vacation for three days. One week after the accident she went to see a doctor again, and now we a have a workers comp case filed. Two weeks later she says her vision keeps getting worse. We found out later that she was also in the process of sueing another local doctor over a different incedent. I think she is making most of this up, it is hard for me belive that such a common household chemical could cause so much damage. Am I wrong? Is goof off so dangerous? Thanks.

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[Andrew_Doan]

Chemical burns can be blinding. Many cleaners contain base, and it can be a serious problem. Refer to this tutorial about ocular trauma:

http://webeye.ophth.uiowa.edu/eyeforum/trauma.htm

CHEMICAL BURNS: POST-IRRIGATION CARE
Base injuries are more worrisome as they can penetrate deeper into ocular tissue. Grading of corneal burns is based on extent of limbal ischemia, which indicates loss of corneal epithelial stem cells, and degree of corneal haze obscurring iris details.

Hughes Classification of Ocular Burns

Grade 1 (Very good prognosis)
No corneal opacity nor limbal ischemia.

Grade 2 (Good prognosis)
Corneal haze but iris details are clear. Less than 1/3 cornea limbus ischemia.

Grade 3 (Guarded prognosis)
Sufficient corneal haze to obscure iris details. 1/3 to 1/2 of cornea limbus ischemia.

Grade 4 (Poor prognosis)
Opaque cornea without view of iris or pupil. More than 1/2 of cornea limbus ischemia.

For chemical burns, injury grade is based on exam before irrigation has begun (it is rare that you will see patients before irrigation is initiated). Start irrigation IMMEDIATELY with Normal Saline or Lactate Ringers Solution (2 liters)—wait 5 min and check pH. Additional irrigation as needed until pH is 7.0-7.5. Continue irrigation until pH is normal—compare pH to the other eye because some pH paper will always read either too alkaline or acidic. Sweep for particulate matter and examine fornices. Check IOP. Call the senior resident. Note limbal ischemia, epithelial defect, stromal loss/haze, edema, AC depth, inflammation, and lens clouding.

MANAGEMENT OF CHEMICAL BURNS
Grading helps to determine the aggressiveness and course of treatment. Treatment modalities include some or all of the following depending on the severity of the burn:
Debride necrotic tissue
Bandage contact lens
Quinolone: 1 gtt 4-6x/day (prevents infection)
Prednisolone phosphate: 1 gtt q 1-2 hr while awake (reduces inflammation)
Vitamin C: 1-2 gm po QD (reduces corneal thinning/ulceration)
10% sodium citrate: 1 gtt q 2 hr while awake (chelates Ca++ and impairs PMN chemotaxis)
Scopolamine 0.25%: 1 gtt TID (reduces pain/scarring with AC inflammation)
10% Mucomyst (n-acetyl-cysteine): 1 gtt 6x/day (mucolytic agent and collagenase inhibitor)
Doxycycline 100 mg po bid (collagenase inhibitor)
Glaucoma gtts/oral diamox if IOP elevated
Significant injury may require admission

 

[cpw]

Dr Doan is right.... alkaline burns can be horrifically nasty. I'd definitely take your employees concerns seriously. All household chemicals have warnings about getting them into your eyes due to the problems listed in Dr Doans post above.