MR CHIKE THE CHEMISTRY TEACHER LOST HIS VISION
OCULAR EMERGENCY:
Mr Chike is a renowned chemistry teacher in the secondary school. The news of his professionalism when it comes to teaching chemistry and handling the praticals have filled the air. As a chemistry teacher, he is often fond of mixing various combinations of chemicals in the laboratory in bid to create a reaction and probably obtain a novel product.
Mr chike was loved by most students and staff for the wonderful and excellent grades he has made students earn in chemistry . His research based mindset always predisposed him to the open risk of contacts with chemical reagents.
The days went by, the WAEC days are here and so Mr Chike started his preparation of fresh chemical reagents. Unfortunate enough the guru dabbled into the chemical preparations without remembering the importance of wearing protective gadgets to guard especially the eyes from chemical splash and burns.
Excellent Chike started the chemical combination with turns upon turns, up and down of bottles and flasks. It was indeed very swift and surprising to him as just a lift of the flask containing diluted NaOH slightly disengaged from his hands and partially emptied onto his face with drips into the eyes. With abrupt reactions , he shouted and cried ‘my eyes’, indeed what an excruciating and blinding pain that he passed through , he couldn’t open his eyes.
Quickly to help him out, students rushed out for water to wash the eye with hope to wash off the chemicals and regain his normal eyes. They made a profused flushing of the eyes. The young guru felt pains and discomfort in the eyes that he dashed off to the nearest chemist shop where he was only given a gentamicin eye drop. Days have passed , Mr Chike felt a bit better hoping for a progress in regaining his eye health but on the contrary, as time went by, he started noticing deteriorations in vision in that eye. Unknown to the guru, the substance that entered his eyes was an alkali and as such will undergo some bonding reactions with the cells and tissues of the eyes to cause progressive damage. Unexplained to him what reactions were going on in his eyes, however the following reactions were taking place on the eyes:
- The alkali dissociated and saponified the fatty acid of the cell membrane thereby destroying structures of the cell membrane of the tissues .
- NaOH being hygroscopic, extracted water from, the cells , causing necrosis ( death ) of the cells .
- Alkali combine with lipids of cells to form soluble compound which produces a condition softening and gelatinization.
Clinically the following reactions were going on in Chike’s eyes:
- Acute ischemic necrosis, this caused Chike’s eyes to get some discharges, redness due to congestion of his conjunctival cells and edema, a wide spread necrosis is going on. Moreso, the corneal cells are not spared as the epithelium sloughs and becomes edematous and its stroma becomes opalescent. The iris gets inflamed and if severe the iris and ciliary body are replaced by granulation tissues.
- There is reparation stage where both conjunctival and corneal epithelium regenerates, hence a presence of corneal vascularisation and inflammation of the iris subsides. Nevertheless at a prolonged stage there would be complications such as symblephron ( joining of the upper and lower eyelids by a sling of flesh), recurrent corneal ulceration and development of complicated cataract and secondary glaucoma.
However Mr Chike stands a chance of avoiding these end stage devils of vision such as cataract and glaucoma by taking a bold step to see the optometrist ( the primary eye doctor). Although early intervention are always better but a mid-stage intervention is still advantageous too as some unforeseen complications will be avoided. Mr Chike actually did the most important step in treating cases of anything the eyes which is by washing the eyes with clean water ( preferably running water), but he failed to visit the Optometrist which is the primary eye doctor responsible to evaluate the condition and treat it . He could have further done the following things to save his vision:
- Immediate and thorough irrigation with clean water or normal saline delivered through syringe, irrigate with about 2litres of water.
- Use of frequent applications of antibiotics.
The above first aid procedures applies to all cases of chemical injuries alkali or acids especially severe that have direct unprotected with the eyes. Entry of substances such lime, paints, detergents, perfumes, cement etc into the eyes should be handled as emergencies. Do not waste any time. See your optometrist immediately.
Immediately your optometrist does the proper management by:
- Further irrigations
- Removal of contaminants in cases of incidence of lime or particulate structures using cotton swabs
- Removal of necrosed conjunctival tissue using cotton swabs.
- Further applications of antibiotics, atropine, steroids and lubricants.
- And follow up care
These would have kept his eyes in safe condition. Do not waste time because chemical are cases of ocular emergencies . Remember the eyes are the windows to your body and mind , guide them well. Chike gradually lost his sight in the worst affected eye.
Many have lost their sight due to ignorance, negligence and by engaging in self management protocol of their eye conditions even in cases of acute trauma and would only present to the optometrist at the stage when the damages to the eyes are seemingly irreversible. Remember interventions at the early stages of cases gives over 78% of success in healing . Never neglect the essence of seeing your eye doctor both for preventive and management conditions.
Forms of ocular injuries:
- Mechanical injuries
- Chemical injuries
- Electrical injuries
- Thermal injuries
- Radiational injuries
useful tips in managing emergencies:
- profusely wash your eyes with running water, preferrably use normal saline
- apply antibiotic eyedrop and keep the eyes quiet
- immediately visit the Optometrist (eye doctor).
