Ascorbate for alkali burns to the eye
Date First Published:
January 24, 2003
Last Updated:
September 5, 2003
Report by:
Kevin Mackway-Jones, Consultant (Manchester Royal Infirmary)
Search checked by:
Janet Marsden, Manchester Royal Infirmary
Three-Part Question:
In [patients with alkali eye burns] do [ascorbate drops] [reduce short-term symptoms and long-term sequelae]?
Clinical Scenario:
A 22 year old man has been cleaning out an old chemical drum. He attends the emergency department with severe burning in his eyes. He says the drum was marked as NaOH 20%. You arrange for copious irrigation and oral pain relief. You contact the duty opthamologist who asks to start mydriatics, antibiotic ointement and ascorbate drops. You do not have the ascorbate drops and wonder whether there is any evidence for their use.
Search Strategy:
Medline 1966-06/03 using the OVID interface.
Search Details:
{[(injury.mp OR exp "wounds and injuries" OR exp burns OR burn$.mp) AND (eye$.mp OR exp eye)] OR (eye injury.mp OR eye injuries.mp OR exp eye injuries OR eye burn$.mp OR exp eye burns)} AND (alkali$.mp OR exp alkalies) AND (ascorbate$.mp OR ascorbic acid.mp OR exp ascorbic acid OR vitamin C.mp)
Outcome:
Altogether 33 papers found of which 1 was relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Management of alkali burns: an 11-year retrospective review. Brodovsky SC, McCarty CA, Snibson G et al. 2000, Australia | 121 patients with 177 alkali burnt eyes over 11 years. Standard alkali protocol (antibiotics, intensive topical steroids, ascorbate, citrate and antibiotics) vs conservative protocal (antibiotics, short course of steroids) |
Retrospective clinical comparison | Time to re-epithelialisation | Delay in grade 2 burns. Trend for longer in 1, shorter in 3 and no difference in 4 | Uncontrolled. Very few conservatively treated patients Conclude that ascorbate and citrate are the effective agent for grade 3 burns without considering the effect of intensive steroid alone |
| Final visual acuity | Better in grade 3 burns. No difference in 1, 2 and 4 |
Author Commentary:
Ascorbate (and citrate) treatment have been extensively investigated in rabbits but there is no appropriate human data. A randomised controlled trial is mentioned as being underway in papers in 1980, but has not been reported.
Bottom Line:
There is no good evidence for the use of ascorbate in alkali burns in humans. A well designed randomised controlled trial should be performed.
References:
- Brodovsky SC, McCarty CA, Snibson G et al.. Management of alkali burns: an 11-year retrospective review.