Bilateral Chemical Burns of the Cornea Due to Limewater: A Specific Case

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Eyes Chemical burns may be caused by either acidic or alkaline agents (1). Chemical injury of the eyes may produce extensive damage to the ocular tissues, resulting in permanent unilateral or bilateral visual impairment (2). Damage to the cornea as an impotent clear media and refractive structure require clinicians to rapidly assess the level of injury and to take appropriate steps in order to minimize loss of visual function (3). Although the lime as a common alkaline agent has harmful effects to the eye tissues and chemical burns of eye tissues due to lime have been reported (4) but we here present a specific case of bilateral chemical injury of the cornea. An 18-year-old Iranian adult male was admitted at hospital for assessment of chemical burns of both eyes. Past medical history and familial history were normal. The patient was a shepherd and upon returning home from field, he encountered a few children in the alley playing together. A plastic bottle (1.5 liter) with a milky solution has been offered to him as a hoax. The bottle was similar to buttermilk but it contained limewater. The bottle explosion happened as early as it was picked up from ground, and chemical burn of both eyes followed. The patient was dispatched to the hospital for treatment. On physical examination , findings were as follow: Visual acuity (dist) in the right eye was 1m counting finger (CF) and in the left eye was 1.5m CF. Eye movements in both eyes were full. On Slit Lamp Exam: Conjunctiva/Sclera was injected; bilateral corneal edema and haze without any epithelial defect and limbal ischemia was obvious (Figure 1). Intraocular pressure (IOP) in both eyes was 13 mm Hg. Anterior chambers were deep and iris details were visible. No other ophthalmic lesions were seen. After 2.5 weeks treatment and follow up, his visual acuity was 1m CF in the right eye, and nearly 2m CF in the left eye. The corneal opacity did not improve significantly but conjunctive injection reduced. Patient follow-up for more than four years revealed that corneal haze in the left eye relatively improved but the right eye needed corneal transplantation. Alkaline agents like limewater are particularly damaging as they have both hydrophilic and lipophilic properties, which allow them to rapidly penetrate cell membranes and enter the …