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Author: Wagoner MD, Anterior Segment/External Disease Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
Journal: Surv Ophthalmol 1997 Jan-Feb;41(4):275-313
Abstract: Chemical injuries of the eye may produce extensive damage to the ocular surface epithelium, cornea, and anterior segment, resulting in permanent unilateral or bilateral visual impairment. Pathophysiological events which may influence the final visual prognosis and which are amenable to therapeutic modulation include 1) ocular surface injury, repair, and differentiation, 2) corneal stromal matrix injury, repair and/or ulceration, and 3) corneal and stromal inflammation. Immediately following chemical injury, it is important to estimate and clinically grade the severity of limbal stem cell injury (by assessing the degree of limbal, conjunctival, and scleral ischemia and necrosis) and intraocular penetration of the noxious agent (by assessing clarity of the corneal stroma and anterior segment abnormalities). Immediate therapy is directed toward prompt irrigation and removal of any remaining reservoir of chemical contact with the eye. Initial medical therapy is directed promoting re-epithelialization and transdifferentiation of the ocular surface, augmenting corneal repair by supporting keratocyte collagen production and minimizing ulceration related to collagenase activity, and controlling inflammation. Early surgical therapy if indicated, is directed toward removal of necrotic corneal epithelium and conjunctiva, prompt re- establishment of an adequate limbal vascularity, and re-establishment of limbal stem cell population early in the clinical course, if sufficient evidence exists of complete limbal stem cell loss. Re-establishment of limbal stem cells by limbal autograft or allograft transplantation, or by transfer in conjunction with large diameter penetrating keratoplasty, may facilitate development of an intact, phenotypically correct corneal epithelium. Limbal stem cell transplantation may prevent the development of fibrovascular pannus or sterile corneal corneal ulceration, simplify visual rehabilitation, and improve the visual prognosis. Advances in ocular surface transplantation techniques which allow late attempts at visual rehabilitation of a scarred and vascularized cornea include limbal stem cell transplantation for incomplete transdifferentiation and persistent corneal epithelia.
Three Army soldiers were on their way to us following an explosion of an improvised device. The driver had goggles on and suffered extensive facial trauma and all three had eye injuries from the debris that hit them. We got bilateral Morgan Lenses in all three and flushed each with several liters of LR. Followed with antibiotics, they were rebandaged and on an emergency air evacuation that evening. These men were grateful for the care they received. The technicians and physicians here are thankful that everyone knew what to do to get the lens system set up and running. I am grateful to you for the opportunity to access the class online and ability to present it shortly after we arrived. One of the others did have a corneal laceration that we could assess after flushing. We feel confident that all will have the best outcomes thanks to the Morgan Lens use.
We also had a patient who experienced an electrical explosion (a generator) to his face. We used Morgan Lenses to irrigate his eyes and sent him on an air evacuation flight to Germany. He has since returned to duty and is doing well with minimal residual sight loss.Military Registered Nurse (Active Duty)
The Morgan Lens is used in 90% of hospital emergency departments in the USA and can be inserted in less than 20 seconds. There simply is no other "hands-free" method of eye irrigation. Nothing else frees medical personnel to treat other injuries or to transport the patient while irrigation is underway. Nothing is more effective at treating ocular chemical, thermal, and actinic burns or removing non-embedded foreign bodies, even when the patient's eyes are closed tightly. Its design makes it simple and straightforward to use so minimal training is required.