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CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 2  |  Page : 87-89

Labial mucus membrane graft for alkali injury


Department of Cornea and Refractive Surgery, Sankara Eye Centre, Coimbatore, India

Date of Web Publication10-Jan-2014

Correspondence Address:
Vipul Bhandari
Department of Cornea and Refractive surgery Sankara Eye Centre, Sivanadapuram, Sathy Road, Coimbatore - 641 035, Tamil Nadu
India
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DOI: 10.4103/1858-540X.124845

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  Abstract 

The case report of a 60-year-old man has been presented to report the treatment of alkali injury with labial mucus membrane graft. The patient presented with fall of cement in the right eye. He had perilimbal ischemia and corneal epithelial defect and his cornea was hazy. A diagnosis of severe alkali injury was made. The cement particles were removed. He was started on topical antibiotics, steroids, cycloplegic and lubricants. Later, he developed symblepharon and perilimbal ischemia, and the corneal epithelial defect was still present. A labial mucus membrane grafting was performed. An amniotic membrane was placed over the ocular surface and a conformer was placed and topical steroids, antibiotics and lubricants were continued. At follow-up, it was noted that the graft was taken up well and her best corrected visual acuity improved to 6/18.

Keywords: Alkali injury, labial, mucus graft


How to cite this article:
Bhandari V, Reddy JK, Mahajan R. Labial mucus membrane graft for alkali injury. Sudanese J Ophthalmol 2013;5:87-9

How to cite this URL:
Bhandari V, Reddy JK, Mahajan R. Labial mucus membrane graft for alkali injury. Sudanese J Ophthalmol [serial online] 2013 [cited 2019 Jul 15];5:87-9. Available from: http://www.sjopthal.net/text.asp?2013/5/2/87/124845


  Introduction Top


The conjunctival epithelium provides a source of cells to repopulate the corneal surface when the entire corneal epithelium has been denuded and the limbal stem cells have been destroyed, as in severe chemical injuries. In alkali injury, intervening in the late phase and using amniotic membrane graft to rehabilitate the ocular surface are not satisfactory. We report a case treated in the initial period with labial mucus membrane graft to rehabilitate the ocular surface. To the best of our knowledge, such favorable outcome has never been reported. Although this is an isolated case, it is worth a mention.


  Case Report Top


A 60-year-old male of Indian origin presented with accidental fall of cement in his right eye. He came to us after 2 days of the incident and had not taken any treatment. His best corrected visual acuity in the right eye was counting fingers close to his face and 20/60 in the left eye. Slit-lamp biomicroscopy in the right eye demonstrated perilimbal ischemia from 9'0 clock to 2'0 clock (6 clock hours) [Figure 1], cement particles all over the palpberal conjunctiva [Figure 2] and large corneal epithelial defect measuring 10 mm x 8 mm, and his cornea was hazy [Figure 3]; the iris details were not clear. On eversion of the upper eyelid, cement particles were found in the upper fornix.
Figure 1: Perilimbal ischemia

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Figure 2: C ement particles over the conjunctiva

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Figure 3: Epithelial defect

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A diagnosis of severe alkali injury was made [Table 1]. Thorough saline wash was given to remove the cement particles, but the cement particles were adherent to the conjunctiva. Under peribulbar anesthesia, the cement particles were removed in an operating theater and eversion and double eversion of the lid was done, removing all the cement particles. Postoperatively, he was started on topical antibiotics, steroids, cycloplegic, lubricants and sweeping of glass rod to keep the fornices clear.
Table 1: Grading of alkali injury


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One week later, he developed broad-based symblepharon in the upper fornices [Figure 4], perilimbal ischemia was still present and corneal epithelial defect was still of the same size. The symblepharon was released and the scarred conjunctiva was excised. A labial mucus membrane graft 3 cm x 1 cm was taken after separating the subcutaneous fat and sutured to the excised margins of the palpberal conjunctiva and the limbal area. An amniotic membrane was placed over the ocular surface, a conformer was placed to prevent symblepharon formation [Figure 5] and topical steroids, antibiotics and lubricants were continued. After 1 week, the graft had taken up well and the epithelial defect had reduced in size. At 3 weeks follow-up, the graft had taken up well, the epithelial defect had healed and his best corrected visual acuity improved to 6/18 [Figure 6].
Figure 4: Symblepharon

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Figure 5: Conformer

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Figure 6: Labial mucus membrane graft

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  Discussion Top


Alkalis penetrate by hydrolyzing structural proteins and dissolving cells by liquefactive necrosis. [1] The most common alkali involved in ocular injury is calcium hydroxide (lime). [2]

The conjunctival epithelium provides a source of cells to repopulate the corneal surface when the entire corneal epithelium has been denuded and the limbal stem cells have been destroyed, as in severe chemical injuries. [2]

Our patient had a severe alkali injury with perilimbal ischemia and corneal epithelial defect. [3]

One week later, he developed symblepharon even with treatment. Symblepharon was excised and the scarred conjunctiva was removed as well. The defect left was too big for a conjucntival autograft. In our past experience with alkali injury, intervening in the late phase and using amniotic membrane graft to rehabilitate the ocular surface were not satisfactory. In this case, with early intervention, we went ahead with labial mucus membrane graft of the same size retrieved from the lower lip of the patient. The patient responded very well to our treatment. To the best of our knowledge, such favorable outcome has never been reported; although this is an isolated case, it is worth a mention.

 
  References Top

1.Vukosavljevic´ M, Thomas J. Ocular Emergencies, The Chicago Eye and Emergency Manual, Volume 1, 1 st Ed, Chapter 13. New Delhi, India: Jaypee Brothers Medical Pub; 2011. p. 361-4.  Back to cited text no. 1
    
2.Available from: http://www.oculist.net/downaton502/prof/ebook/duanes/pages/v4/v4c028.html [Last accessed on 2013 Jun 02].  Back to cited text no. 2
    
3.Dua HS, King AJ, Joseph A. A new classification of ocular surface burns. Br J Ophthalmol 2001;85:1379-83.  Back to cited text no. 3
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1]



 

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