Dr. Priya Srinivas Frcs, Cornea Fellow, Sankara Nethralaya Shree Eye Care, Mumbai

1. Astigmatism after corneal thermal injury
Dr. Priya Srinivas FRCS,
Cornea Fellow, Sankara Nethralaya
Shree Eye care, Mumbai
Case Report

2. Purpose
To report a case of high astigmatism
induced by a thermal burn to the cornea
and its regression over a period of 19 months

3. Methods

A 43 year gentleman presented with accidental thermal injury
to the left eye with a burning agarbatti(incense stick) 15 days
before presentation

He complained of blurred vision in the left eye

He was prescribed topical steroids, antibiotics and lubricants
by the referring clinician for 2 weeks

4. Clinical Presentation
Eye UCVA BCVA
(pinhole)
Near
vision
Right eye (OD) 6/6 6/6 N6
Left eye (OS) Finger
counting at 3m
6/36 N36
Eye OD OS
Lids Normal Normal
Conjunctiva/fornices Normal Normal
Limbus Normal Normal
Cornea Normal Abnormal distortion of temporal cornea,
DM folds, scarring
AC Normal Normal
Iris / Pupil Normal Normal
Lens Normal Normal
Fundus Normal Normal
IOP ( GAT) 18mm Hg 30 mm Hg

5. Topography

K1- 53.48 D @160

K2 - 43.41 D @70

Diff =10.07 D
Cyl 10.07 D

6. Methods

No improvement with spectacle correction

Anti-Glaucoma medication - Brimonidine plus timolol eyedrops
twice daily was prescribed

Steroids eyedrops were tapered and stopped

Option of Contact lenses(RGP) trial after stabilization of
topography was discussed

7. Results - 4 months follow up
Eye OD OS
Lids Normal Normal
Conjunctiva/fornices Normal Normal
Limbus Normal Normal
Cornea Normal DM folds, scarring,
distortion less obvious
AC Normal Normal
Iris / Pupil Normal Normal
Lens Normal Normal
Fundus Normal Normal
IOP ( GAT) 18mm Hg 08 mm Hg
Eye UCVA BCVA
(pinhole)
Near vision
Right eye (OD) 6/6 6/6 N6
Left eye (OS) 6/18 6/9 N10
Cyl 7.22D

8. Results - 19 months follow up
Eye UCVA BCVA (pinhole) Near vision
Right eye (OD) 6/6 6/6 N6
Left eye (OS) 6/6 6/6 N6
Eye OD OS
Lids Normal Normal
Conjunctiva/fornice
s
Normal Normal
Limbus Normal Normal
Cornea Normal CLEAR
AC Normal Normal
Iris / Pupil Normal Normal
Lens Normal Normal
Fundus Normal Normal
IOP ( GAT) 18mm Hg 18 mm Hg
Cyl 0.81 D

9. Results (Follow up topography)
Time K1 K2 Cylinder
0 month 53.48 @160 43.41@70 10.07 D
4 months 49.53@156 42.31@66 7.22D
19 months 43.83@135 43.02@45 0.81D

10. Discussion -Literature search
Corneal thermal burns by boiling fluids
1
, firecrackers
1
and electric
curling irons
3
can affect the corneal epithelium (89%) ,
Superficial stroma (8%) and even cause perforation
1
(3%)
A very high corneal astigmatism (6.86 D) was induced by a
thermal burn during a cosmetic eyelid procedure which resolved
partially and the residual astigmatism required an astigmatic
keratotomy
2
11 Vajpayee R B, Gupta NK, Angra SK, Chhabra VK, Sandramouli S, Kishore K. Contact thermal burns of the cornea. Can J Ophthalmol. 1991 Jun;26(4):215-8.Vajpayee R B, Gupta NK, Angra SK, Chhabra VK, Sandramouli S, Kishore K. Contact thermal burns of the cornea. Can J Ophthalmol. 1991 Jun;26(4):215-8.
22 Brian Chou, OD, Brian S. Boxer Wachler, MD .Astigmatism after corneal thermal injury. J Cataract Refract Surg 2001; 27:784–786Brian Chou, OD, Brian S. Boxer Wachler, MD .Astigmatism after corneal thermal injury. J Cataract Refract Surg 2001; 27:784–786
33 Mannis MJ, Miller RB, Krachmer JH. Contact thermal burns of the cornea from electric curling irons. Am J Ophthalmol. 1984 Sep 15;98(3):336-9.Mannis MJ, Miller RB, Krachmer JH. Contact thermal burns of the cornea from electric curling irons. Am J Ophthalmol. 1984 Sep 15;98(3):336-9.

11. Discussion

In our case, the blink reflex didn't help in avoiding / minimizing
the damage

Localized thermal damage caused shrinkage of collagen
fibres (same principle as thermal keratoplasty)

An irregular astigmatism (10D cylinder) was induced by the
thermal burn

The astigmatism resolved with no refractive correction and so
did the visual acuity. We do not know the exact time required
for regression of the astigmatism because there was a gap of
15 months after the 4 month follow up

12. 
Corneal thermal injury can induce a very high irregular
astigmatism because of localized shrinkage of stromal collagen

While RGP CLs form the mainstay of visual rehabilitation,
spontaneous regression of astigmatism over time is likely to
occur

An adequate waiting period of at least one year is recommended
before embarking on any refractive procedure.
Conclusion