- Design
- Retrospective observational case series
- Population
- 20 eyes of 18 patients with carbide gun thermochemical burns at an Indian tertiary centre
- Primary outcome
- Epithelial healing, visual acuity and complications
- Effect
- All eyes epithelialised (mean 22.5 days); logMAR 1.77 to 0.77 at 3 months; repeat graft 21%
Carbide guns, improvised devices that ignite acetylene from calcium carbide and water, have become a seasonal cause of serious eye injury in India. An Indian tertiary eye centre described 20 eyes of 18 patients burned by them during Diwali. All were male, average age about 20, and most injuries were from using the gun directly.
The injuries combine heat and alkali. The median grade on Dua's classification was III. All eyes were irrigated immediately, treated medically and given an overlay amniotic membrane graft early. Every eye healed its epithelium, at a mean of about three weeks, and mean visual acuity improved from logMAR 1.77 to 0.77 at three months. One in five needed a repeat graft. One eye that presented late went on to phthisis.
This is a small series without a comparison group, so it cannot show that amniotic membrane changed the outcome. It does show the pattern of injury to expect and that early aggressive care is achievable.
With Diwali weeks away, emergency departments, GPs and eye units should be ready to irrigate at once and refer grade II or worse injuries the same day.
- Irrigate the eye immediately and copiously before anything else, and check pH where possible
- Sweep the fornices for retained particles of calcium carbide
- Grade the injury and refer moderate or severe burns to an eye unit the same day
- Consider early amniotic membrane grafting for grade III or worse injuries
- Warn young people and parents about carbide guns before the festival
Why it matters
A new festival injury is filling Indian eye casualties every year, and delay worsens outcomes.
Don't overread it
Without a comparison group, the series cannot show that amniotic membrane grafting itself improved the outcome.
The statistics, in plain English
These are averages from 20 eyes with no control group. The improvement in acuity shows what happened with this approach, not what would have happened without amniotic membrane.
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