Verätzungen des Auges können aufgrund einer Dysregulation inflammatorischer Reaktionen
zu schweren Gewebeschäden des Augapfels mit kornealer Fibrogenese und Erblindung sowie
zur Vernarbung der Lider und der ableitenden Tränenwege führen. Augenverätzungen gelten
deshalb als Notfälle höchster Dringlichkeit, wobei die frühzeitige intensive Spülbehandlung
die wichtigste Sofortmaßnahme bildet.
Abstract
Chemical burns of the ocular surface (CBOS) are emergencies of highest urgency. Therefore,
an adequate emergency care is mandatory. Following a precise analysis of the initial
damage, a staged therapeutic approach is used to prevent persistent impairment of
the ocular surface. In the acute stage, the prevention of complications is targeted
(symblepharon, conjunctival scarring, lacrimal stenosis, corneal ulceration, intraocular
inflammation, elevated intraocular pressure, etc.). In later stages, if complications
have developed, a secondary restoration of the ocular surface is focussed. Sometimes
this requires several surgical interventions. Based on a review of international literature,
this review highlights the pathophysiology according to different chemical agents,
CBOS stages as well as main therapy strategies in early and advanced stages of CBOS.
Acute treatment aims to lower inflammation, oxidative stress and tries to promote
reepithelialisation. Besides conjunctival
scarring, loss of goblet cells and corneal opacification a limbal stem cell insufficiency
is the most harming complication. Several new techniques have been developed to recover
the ocular surface with a sufficient and clear epithelial layer in order to avoid
neovascularization of the cornea. The knowledge concerning the high risk potential
for persistent visual impairment in CBOS patients and the ability for appropriate
emergency care should be kept in every physicianʼs mind dealing with CBOS.
