Chemical injury with “packet of chunna” (lime) in children: A major ocular health concern in central rural India

Abstract

Purpose: The purpose of the study is to report the hazardous effect of chunna packet (lime) on ocular surface in terms of pattern of presentation and visual outcome in children. Materials and Methods: Children of age <16 years with definitive history of chemical injury with chunna packet were analyzed. Ocular chemical injury was graded according to Modified Roper Hall grading system. Best corrected visual acuity (BCVA) and anterior segment examination evaluation were compared at time of presentation and at 3 months and categorized on the basis of WHO visual disability classification. Likelihood ratio of BCVA with time of presentation and grade of injuries were calculated using Pearson's correlation coefficient. Results: Eighty eyes of 74 children with a history of ocular burns resulting from lime were included in the study. Of these, 6 patients had bilateral burns. Mean age at the time of injury was 8.44 ± 4.29 years. Many children presented late after 3 weeks of injury (n = 24, 32.4%). The most common grade of injury was Grade 4 (n = 31, 38.8%). Clinical presentations were corneal haze (55%), limbal ischemia (65%), lime particle in fornix (36.2%), corneal scar (33.7%), and symblepharon (22.5%). Surgical intervention was advised in 54 eyes (67.5%) in the form of amniotic membrane grafting, symblepharon release, limbal stem cell transplantation, and tectonic keratoplasty. Mean BCVA at presentation was 1.65 ± 0.99 and at 3 months was 1.39 ± 1.03. Conclusion: Grade of injury and time of presentation were strongly associated with visual outcome in cases of chemical injury with chunna packet.

Keywords

• chemical injury
• chunna packet
• lime injury
• ocular chemical burn