title: Severe ocular injury resulting from chuna packets.
abstract: OBJECTIVE
  To describe a mechanism of severe ocular alkali burns occurring as a result of bursting of chuna packets (edible calcium hydroxide paste), a popular additive to chewing tobacco in India.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Twenty-one patients (25 eyes) who experienced ocular burns as a result of bursting of chuna packets.
  
  
  METHODS
  Patients were treated medically or with 1 or more of the following surgeries: symblepharon release, amniotic membrane grafting, allograft or autograft stem cell transplantation, or both, and large diameter lamellar keratoplasty.
  
  
  METHODS
  The main outcome measures were time interval between the injury and presentation, presenting visual acuity, grade of injury, management (medical therapy or surgical intervention), and final visual outcome at the last follow-up.
  
  
  RESULTS
  The average age at time of injury was 8.4+/-5.5 years. The median visual acuity at presentation was light perception with projection. The ocular burns were grade 4 in 23 eyes. Eight of 25 eyes were treated medically, and the rest underwent 1 or more surgeries in the form of symblepharon release (n = 6), amniotic membrane grafting (n = 3), allograft or autograft stem cell transplantation (n = 6), and large diameter lamellar keratoplasty (n = 6). At the final follow-up (mean, 637+/-592 days), median visual acuity was 1/60.
  
  
  CONCLUSIONS
  Bursting of chuna packets can cause severe ocular alkali burns in children. These patients carry a poor visual prognosis with both medical and surgical therapy.
authors.affiliation: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science, New Delhi, India.
authors.forename: Tushar
authors.initials: T
authors.lastname: Agarwal
authors.forename: Rasik B
authors.initials: RB
authors.lastname: Vajpayee
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
authors.forename: Radhika
authors.initials: R
authors.lastname: Tandon
mesh_terms: D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000637:transplantation; D002057:Burns, Chemical / Q000145:classification / Q000209:etiology* / Q000601:surgery; D002126:Calcium Hydroxide / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000187:drug effects* / Q000601:surgery; D003315:Cornea / Q000187:drug effects* / Q000601:surgery; D016039:Corneal Transplantation; D005126:Eye Burns / Q000139:chemically induced* / Q000145:classification / Q000601:surgery; D005143:Eyelids / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D014792:Visual Acuity / Q000502:physiology
chemical_list: D002126:Calcium Hydroxide