Healing of cornea following an electric burn

Abstract

Electrical injuries have become a significant health problem in developing countries because of increase in access to electricity in the last few decades and lack of adequate safety measures. Electrical injuries of eyes are relatively uncommon. A case report of a rapid and complete corneal healing accompanied by satisfactory visual recovery after an electric burn event in a 20-year-old male is reported. The patient had accidental exposure to high voltage live wire while he was repairing it, resulting in severe ocular and superficial body burn. He was not wearing any protective equipment at the time of injury. On examination, the best-corrected visual acuity was counting fingers in the left eye with severe corneal epithelial loss and diffuse corneal oedema. The patient was treated medically, with a rapid corneal healing and resolution of oedema over the next few days. Visual acuity in the worse eye (left) improved to 20/25 from counting fingers.

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Journal of the College of Physicians and Surgeons Pakistan 2012, Vol. 22 (8): 533-535 533
INTRODUCTION
Electrical injuries have emerged as a significant health
problem in developing countries because of increase in
electrification of rural areas in the last few decades and
lack of adequate safety measures.1Electrical eye or
orbital injuries are not common events. However, they
have a broad spectrum, ranging from minimal injury of
the lid to complete retinal detachment and total
blindness.2-6
Boozalis and colleagues reviewed 159 cases of electric
burns to determine the ocular sequelae of such injuries.7
Only 5 (3.1%) of them had eye manifestation (number)
including recurrent iritis, cataract, macular holes and
central retinal artery occlusion.7Of those who had
electric-burn associated cataracts, 3 had anterior sub-
capsular opacification while one had a dense white
opacified lens. Ocular changes such as macular cysts,
optic nerve damage and retinal changes8-10 have also
been reported. Careful follow-up is recommended
because many such cases develop delayed ocular
changes.
A case report of an electric eye burn event in a 20-year-
old male is reported below. Rapid and complete healing
of the affected cornea was observed with satisfactory
visual recovery because of timely presentation and
management.
CASE REPORT
A 20-year-old male presented to the Emergency
Department of the Aga Khan University Hospital,
Karachi, in mid-afternoon with a history of electric burn
received at a local Jamat Khana (religious centre for the
Ismaili community) an hour and a half before
presentation. He was transported on a stretcher by his
elder brother who confirmed history of electric shock
induced by high voltage wire while repairing a cable fault
unprotected. He did not have any previous significant
medical or ocular history.
On presentation, the patient was conscious and well-
oriented and vitally stable with a heart rate of 91 per
minute and respiratory rate of 22 per minute. He was
hydrated with normal saline and given a good pain
control. Baseline investigations included electro-
cardiogram (ECG), complete blood count, serum
electrolytes and random blood glucose. The patient had
ocular complaints of intense burning and blurring of
vision, predominantly on the left side. These were
associated with watering and pain in both eyes.
Systemic injuries included first degree superficial skin
burns over the left half of the face, scalp and dorsum of
the left hand.
An initial eye examination was carried out in the
emergency department. He had a poor visual acuity of
counting fingers in the left eye and a good visual acuity
of 20/25 in his right eye. He had difficulty in opening his
left eye due to burnt lashes matted together and charred
skin in the peri-orbital region. Extra-ocular movements
were normal and the pupils were regular and reacting to
light. After gentle irrigation with normal saline, a
thorough slit-lamp examination was performed. His left
eye had a deeply-congested conjunctiva and a diffuse
corneal epithelial burn with areas of epithelial loss. The
right eye was less affected with marked conjunctival
congestion and multiple corneal punctate epithelial
staining. The anterior chamber was deep and the lens
appeared clear in the right eye, while anterior chamber
reaction in the left eye could not be assessed due to
CASE REPORT
Healing of Cornea Following an Electric Burn
Tanveer Anjum Chaudhry, Farheen Shaikh and Khabir Ahmad
ABSTRACT
Electrical injuries have become a significant health problem in developing countries because of increase in access to
electricity in the last few decades and lack of adequate safety measures. Electrical injuries of eyes are relatively
uncommon. A case report of a rapid and complete corneal healing accompanied by satisfactory visual recovery after an
electric burn event in a 20-year-old male is reported. The patient had accidental exposure to high voltage live wire while
he was repairing it, resulting in severe ocular and superficial body burn. He was not wearing any protective equipment at
the time of injury. On examination, the best-corrected visual acuity was counting fingers in the left eye with severe corneal
epithelial loss and diffuse corneal oedema. The patient was treated medically, with a rapid corneal healing and resolution
of oedema over the next few days. Visual acuity in the worse eye (left) improved to 20/25 from counting fingers.
Key words: Electric burn. Cornea. Healing. Ocular burn.
Department of Surgery, Section of Ophthalmology, The Aga
Khan University Hospital, Karachi.
Correspondence: Dr. Tanveer Anjum Chaudhry, 134/11, P-Street,
DHA, Phase VII, Karachi.
E-mail: tanveer.chaudhry@aku.edu
Received November 10, 2011; accepted February 24, 2012.

marked corneal haze. Posterior segment examination
was also not possible in this eye.
After anaesthetizing both eyes with lignocaine 0.5% eye
drops, the superficial epithelial layer of patient's left eye
was debrided using cotton wool buds. Topical antibiotic
and dilating eye drops (1%) were instilled and the eye
was padded for the next 48 hours. For the right eye,
antibiotic 0.5% eye drops, mydriatic eye drops 1% and
prednisolone 1% eye drops were prescribed. Plastic
surgery and dermatology consults were generated who
advised emollients and topical anti-bacterial skin cream.
The patient was kept under observation for 24 hours and
discharged in a stable condition on oral analgesics.
On the third day of injury, the left eye pad was removed
and the patient was re-examined. There was a
remarkable improvement in visual acuity from counting
fingers at presentation to 20/25 in his severely affected
left eye. Slit-lamp examination showed mild conjunctival
congestion and a clear cornea with a small linear stain-
positive epithelial defect in the lower half of cornea. Rest
of the anterior segment examination was normal. By
contrast, the right eye showed few superficial punctate
erosions only. The intraocular pressure was normal. The
posterior segment of both the eyes was assessed the
same day and was found to be normal. The patient was
advised to continue topical treatment for a week, which
was gradually tapered off. Ten days after the injury, the
patient had a good visual acuity of 20/20 in the right eye
and 20/25 (best-corrected) in the left one. The cornea on
both sides was found to be clear.
DISCUSSION
Electricity can be a serious health and environmental
hazard, especially in developing countries where
protective measures are almost non-existent.1These
hazards include contact injuries, electric shocks,
electrocutions, burns, fires, explosions and falls. We
reported an electric eye injury involving a young adult
who not only survived a high voltage trauma but also
had a rapid and complete recovery from corneal burns.
There are many factors that determine the severity of
the electric damage and its outcome. These include the
type of current, the duration of exposure, the type of
tissue surface contact, the extent of multisystem
involvement, the duration between exposure and
presentation and the extent of adherence to treatment.
Electric eye injuries are uncommon events and this
reported case had a rapid and complete healing of the
cornea because of early referral, timely management
and good treatment compliance.
There is a wide spectrum of ocular injuries associated
with exposure to electricity.3,4,6 These include corneal
burns, intraocular bleeding, thrombosis, cataract, glaucoma,
retinal detachments. Severe lid burns from electrical
exposure can also lead to various other complications
such as loss of eye lashes and misdirected lashes (as
was the case in our patient; Figure 1-3), and lid
malpositioning. Thus ophthalmologists should not only
focus on the presenting injuries, but also be aware of the
long-term ocular complications.
It is important to note that electrical eye injuries are
largely preventable by taking simple and time-tested
protective measures such as the use of rubber insulating
gloves and shoes, and industrial protective helmets.
The victim was not a trained electrician with little
knowledge of the potential electric hazards. He was
working unprotected with no helmet, bare hands and
feet. Targetted public awareness programmes can not
only save many eyes from going blind but can also save
many lives. This case report highlights the importance of
seeking immediate medical attention, early intervention
and targetted awareness programmes on electricity-
related ocular and non-ocular hazards.
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Tanveer Anjum Chaudhry, Farheen Shaikh and Khabir Ahmad
534 Journal of the College of Physicians and Surgeons Pakistan 2012, Vol. 22 (8): 533-535
Figure 1: Corneal damage with charred and lost
eyelashes in the left eye at presentation.
Figure 3: Completely healed left cornea following
treatment.
Figure 2: Corneal haze with charred and lost
eyelashes in the right eye at presentation.

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Healing of cornea following an electric burn
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