Chemical Burn and Limbal Stem Cell Deficiency in Pictures
DOI:
https://doi.org/10.55677/IJCSMR/V2I7-01/2022Keywords:
limbal stem cell deficiency, eye burnAbstract
The stem cells located at the limbic level are responsible for the renewal of the corneal epithelium, in a physiological situation, but also for healing.
The can be of very diverse etiologies, including eye burns, whether by acid or by base. Burns by bases are more serious than those by acids, in fact, due to their chemical properties, bases quickly penetrate cells to reach deep tissues. In these cases the destruction of the limbus and its stem cells leads to corneal epithelial regeneration from the epithelium of the bulbar conjunctiva. The cornea will then be invaded by the conjunctival epithelium and will change its phenotype.
To illustrate this syndrome, we report the case of a 19-year-old patient, with no particular medical history, seen in our training following bilateral ocular burns by lime while performing domestic chores (Base, pH= 12.3).
The initial examination found visual acuity with “hand movements” in both eyes, with grade III base burn on the right and grade IV on the left according to the Hughes classification modified by Ropper Hall, with bilateral central corneal ulcer.
The evolution was marked by the occurrence of a Limbal stem cell deficiency, with the appearance of a bilateral 360° vascular call, and a chronic ulcer in the left eye.
Limbal stem cell deficiency are mainly found in grades 3 and 4, which include extensive limbic ischemia, which is the case of our patient. As for the treatment of chemical burns by bases, the ocular wash is the first step which must be carried out quickly and abundantly, followed by medical treatment.
But when a Limbal stem cell deficiency occurs, limbal transplantation is the appropriate treatment, even if the time taken to perform this transplantation still seems to be a subject of controversy: the intervention time must be less than 4 months for Gatinel and collaborators, but longer for Rao and collaborators, who believe that this improves the prognosis due to the absence of inflammation and ischemia.
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