Management of alkali burns : an 11-year retrospective review

Ophthalmology. 2000 Oct;107(10):1829-35. doi: 10.1016/s0161-6420(00)00289-x.


Objective: To review the spectrum of patients with alkali burns admitted over an 11-year period and to assess the clinical outcomes after the introduction of a standard alkali burn treatment protocol.

Design: Retrospective nonrandomized comparative study.

Patients and interventions: A total of 121 patient records with alkali burns (n = 177 eyes) admitted to a tertiary hospital between 1987 and 1998 were reviewed. Eyes treated with a standard alkali burn treatment protocol, which included intensive topical steroids, ascorbate, citrate, and antibiotics, were compared with eyes treated by conservative management with antibiotics, and a short course of steroids.

Main outcome measures: Time to corneal reepithelialization, final best-corrected visual acuity, and time to visual recovery, length of hospital stay, and complications were analyzed.

Results: The standard protocol tended to delay corneal reepithelialization by one day (P: = not significant) in eyes with grade 1 burns (n = 76) and by 2 days (P: = 0.04) in grade 2 burns (n = 52), with no difference in final visual outcome. There were 37 eyes with grade 3 burns. Those treated with the standard protocol showed a trend toward more rapid corneal reepithelialization. Twenty-seven of 29 (93%) eyes with grade 3 injuries achieved a final best-corrected visual acuity of 20/40 or better compared with 3 of 6 (50%) eyes not treated according to the standard protocol (P: = 0.02). Eyes with grade 4 burns (n = 12), whether treated with the standard protocol or not, required 10 to 12 weeks for corneal reepithelialization. There was no statistically significant difference in final visual acuity.

Conclusions: On the basis of our findings, a number of recommendations can be made for the management of alkali injuries. Patients with a grade 1 or 2 injury do not require routine admission and do not benefit from the use of intensive treatment with ascorbate and citrate. A trend toward more rapid healing and a better final visual outcome were apparent in grade 3 burns, but our standard protocol made no difference in grade 4 burns.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Adult
  • Alkalies / adverse effects*
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Ascorbic Acid / therapeutic use
  • Burns, Chemical / classification
  • Burns, Chemical / drug therapy*
  • Burns, Chemical / physiopathology
  • Citric Acid / therapeutic use
  • Drug Therapy, Combination
  • Epithelium, Corneal / drug effects
  • Epithelium, Corneal / physiology
  • Eye Burns / chemically induced*
  • Eye Burns / classification
  • Eye Burns / drug therapy
  • Eye Burns / physiopathology
  • Female
  • Glucocorticoids
  • Hospitals, Special
  • Humans
  • Male
  • New South Wales
  • Ophthalmic Solutions / therapeutic use*
  • Ophthalmology
  • Retrospective Studies
  • Treatment Outcome
  • Wound Healing / drug effects


  • Alkalies
  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Glucocorticoids
  • Ophthalmic Solutions
  • Citric Acid
  • Ascorbic Acid