Restoration of vision after alkali
burn in 11 year old boy
Suzie Nemmers, MD 1 Jason Sorell, DO 1
John Campagna MD, MPHTM 2, Shane McEntire MD3
1Dept Ophthalmology, 2Dept of Pediatrics 3Dept of Surgery
Tripler Army Medical Center
The views expressed in this poster are those of the authors and do not reflect the official policy
or position of the Department of the Army, Department of Defense of the U.S. Government.
All authors have no financial interests
To report the restoration of visual acuity in an
11 year old boy after medical treatment of a
severe alkaline burn of both eyes.
Ocular alkaline burns to the eyes denature proteins in the cornea, conjunctiva,
and other ocular structures. The release of collagenases and proteases after
injury leads to corneoscleral melting.
The role of topical steroids in corneoscleral melting is controversial as they
have been postulated to exacerbate this condition.
Adjunctive therapy with mucomyst, doxycycline, and amniotic membrane
help prevent corneal melting.
Amniotic membrane is effective at promoting re-epithelization, reducing
inflammation, and scaring.
Mucomyst inhibits collagenase whereas tetracyclines exert anti-collagenolytic
effects by inhibiting activities of human interstitial collagenases and by
preventing the oxidative activation of latent pro-collagenases.
Study Design: Observational case study
“The study protocol was approved by the Human use Committee at Tripler Army Medical center. Investigators adhered to the policies
for protection of human subjects as prescribed in 45CFR 46”
An 11 year old boy sustained ocular alkaline burns bilaterally. After copious
irrigation for two days, the ocular pH normalized from ph 9.0.
Then he was treated with aggressive medical therapy, which included
maxitrol, mucomyst, doxycycline, erythromycin, and cyclopentolate.
Later, diamox was added to treat elevated intra-ocular pressure.
He developed symblepharons and large epithelial defects bilaterally (OD >
OS). Therefore Prokera was applied to the right eye and a bandage contact
lens to the left. Then Vigamox and pred-forte were started for 1 week. He
was maintained on mucomyst, diamox, doxycycline and lotemax for six
Symblepharon excission was performed .
His visual acuity improved to 20/20 bilaterally. Minimal corneal
neovascularization occurred in the right eye.
POST-TREATMENT Post treatment Post
Prompt and aggressive medical treatment can
restore visual acuity in severe ocular alkali burns.
Mucomyst and amniotic membrane may be an
important adjunctive therapy in restoring vision.
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