Surgical rehabilitation following severe ocular burns.

Chemical and thermal burns can cause devastating injuries to the anterior segment. The consequences of alkali injuries are notoriously severe due to the rapid penetration of these agents into the ocular tissues. Denaturation of tissue, inflammation, and scarring leads to loss of function. An understanding of the pathogenesis of tissue damage has lead to a rational approach to treatment. Emergency irrigation of the eye is essential and there is a 'window of opportunity' during the first 7-10 days after injury when medical treatment can significantly limit the potentially blinding consequences. The acute injury is followed by early and late reparative phases during which the prognosis can be further improved by surgical intervention. Early surgical intervention is targeted at protecting the ocular surface and encouraging re-epithelisation. Later, surgical treatments are directed at ocular surface reconstruction and restoration of vision. However, before any attempt is made at surface reconstruction, the ocular surface environment must be optimised by division of symblepharon, and correction of lid deformity and trichiasis. If there is conjunctivalisation of the corneal surface, limbal stem cell transplantation can restore a corneal epithelial cell phenotype, and transplantation of in vitroamplified corneal epithelial stem cells has been developed as an alternative to keratolimbal transfer techniques. Keratoplasty and cataract surgery may then be necessary to clear the visual axis. Finally, keratoprosthesis is an option for the most severely damaged eyes.