Purpose: We report the results of a three-years prospective study focusing on ocular alkali burns conducted in the University hospital of Fort de France (French West Indies).
Patients and methods: This case record survey included all alkali burns evaluated by ophthalmologists in the emergency unit of the Fort de France hospital. All recruited patients were either called to identify the alkali (pH determined with a Prolab pH-meter) or underwent an anterior chamber puncture showing evidence of an aqueous humor pH above 8. The recorded data were: age, gender, cause of burn, in case of aggression the relation between the victim and the aggressor, initial clinical findings, Ropper Hall classification. The therapeutic protocol was initiated according to this classification. The course of the ocular burn was noted. Economical and medicolegal consequences were assessed from duration of off work time and from information provided by the public prosecutor respectively.
Results: Twenty-four patients who had 39 burned eyes were included. Most ocular burns (18) were caused by aggressions with Alcali (ammonia, pH = 12.8). Most victims were men accused of adultery. In the West Indies, Alcali is thought to have power to drive away evil spirits. Most victims were young men (mean age 42 years). Eight court suits have been filed and in 5 cases the judge dismissed the charge. In 13 eyes, the delay to the first ocular wash was 30 minutes and resulted in serious ocular burn (Ropper Hall class 3 or 4). After application of the therapeutic protocol, 6 of these eyes recovered in an average 55 days; 3 required limbal autograft, 2 were successful. Three of these severe burns were complicated by spontaneous perforation (1 eye), atrophy (1 eye), and leucoma (1 eye). One patient was lost to follow-up. All minor ocular burns (Ropper Hall class 1 and 2) healed within an average 12 days (range 3-38 days).
Conclusion: Particular circumstances of ocular alkali burns in Martinique (French West Indies) have been indentified in this study which established the seriousness of these burns and their social and sometimes legal consequences. The importance of prevention is emphasized. It would seem that minor ocular alkali burns do not require a treatment duration longer than 15 days. Finally, the clinical data reported in this study show that a delay of several minutes is required for the development of severe ocular alkali burns.