Exploding Gunpowder
Sodium Hydroxide
Industrial Cleanser
Powdered Lime
A nine-year-old boy ignited a pile of gunpowder with a match in his garage. The result was second degree burns to his face, eyelids, neck and upper shoulders. His eyes were open during the explosion. In the inter-palpebral fissures he suffered severe corneal burns. The cornea was edematous with large amounts of gunpowder buried in the corneal tissue. He was unable to keep his eyes open because of the severe pain and photophobia.
After instillation of a topical anesthetic, a Morgan Lens was placed in each eye allowing lactated Ringer's solution to flow. No other medication was given and the pain was completely gone within two hours of the insertion of the Morgan Lens. Treatment was continued for another twenty-four hours.
While being observed, the charred epithelium and gunpowder were seen flowing free from both corneas and being washed away. At the end of the 24-hour period both corneas were clear and vision was back to 20/25 within 10 days after the procedure. Full recovery was expected.
The patient fell face first into a tank of 190° Fahrenheit sodium hydroxide solution sustaining 67% total body surface burns, including the eyes, back, and neck. His eyes had been rinsed at the scene but his corneas were opacified.
In the Burn Unit, nurses immediately inserted Morgan Lenses and irrigated using two liters of normal saline per hour. When he was examined by Ophthalmology an hour and a half after the accident, his vision was so reduced that he could only distinguish light from dark. The epithelium was absent from both corneas, and both were marbleized. The diagnosis: severe alkali burns to both eyes, right worse than left.
The pH on the first anterior chamber tap was greater than 8.0. After the third tap and reconstitution of the aqueous, the pH was reduced to 7.0
Corneal irrigation using the Morgan Lens continued at the same rate for another four hours, while emergency burn resuscitation proceeded on the rest of the body. The Morgan Lenses were removed after five and one half hours, and 20 minutes later the conjunctival pH was less than 7.0.
Seven months later a successful corneal transplant restored the vision of the right eye to 20/40 with a contact lens. The success of this operation was dependent on the viability of the patient's peripheral cornea, which was maintained by the timely and persistent use of the Morgan Lens*. The unaided vision in the left eye was 20/50.
*Albrecht v. Graefes Arch. klin. exp. Opthal. 195, 33-40 (1975)
Following accidental exposure to an industrial cleanser, a 32-year-old man suffered severe eye pain, inflammation, photophobia, and a decrease in visual acuity. Without correction, the visual acuity was 20/100 in the right eye and 20/25 in the left.
Through an extensive series of procedural tests he was diagnosed to have periorbital caustic burns, conjunctival caustic burns, corneal abrasions, and traumatic iritis in the right eye.
He was treated with opticaine drops three times in each eye, with Homatropine 5%, instilled in the right eye. The Morgan Lenses were then placed in each eye and a flow of lactated Ringer's solution was started. After one hour, the lenses were removed and the slit lamp showed marked improvement in all areas.
Within one week, including daily visits, the vision was 20/20 in each eye, the iritis was gone, and the periorbital area was healed. No further treatment was needed.
A five-year-old boy had powdered lime thrown in his face with his eyes open. At the accident site, the neighbors irrigated the eyes profusely, but there was still a considerable amount of powdered lime removed in the Emergency Department forty-five minutes later.
There was moderate lid edema, more marked on the left, with discrete left corneal opacities inferiorly. Morgan Lenses were inserted in each eye with lactated Ringer's solution running at 60 cc per hour. This was continued for a 24-hour period to insure complete irrigation.
Three days later there was a shallow ulcer involving the inferior portion of the left cornea. This ulcer diminished over the next five days and was completely healed two weeks later.
One year after the accident there was no evidence of conjunctival scarring or other abnormalities. Corrected visual acuity in the left eye remained at 20/30, the same as recorded prior to the accident.
