Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Burn of Eye


Related Terms

  • Eye Burn
  • Flash Burn
  • Keratitis Photoelectric
  • Ocular Burn
  • Snow Blindness
  • Ultraviolet Keratitis
  • Ultraviolet Keratopathy
  • Ultraviolet Radiation Injury
  • UV Keratitis
  • UV Keratopathy
  • UV Radiation Injury
  • Welder's Arc Burn

Differential Diagnosis

  • Corneal ulceration
  • Floppy eyelid syndrome
  • Keratitis sicca
  • Nocturnal lagophthalmos
  • Ulcerative keratitis
  • Ultraviolet keratitis

Specialists

  • Emergency Medicine Physician
  • Ophthalmologist
  • Plastic Surgeon

Factors Influencing Duration

Factors that may influence duration include nature of the injury (unilateral or bilateral), depth and severity of the burn, involvement of other body parts, and development of ophthalmic complications.

Medical Codes

ICD-9-CM:
940.0 - Chemical Burns of Eyelids and Periocular Area
940.1 - Burns of Eyelids and Periocular Area, Other
940.2 - Alkaline Chemical Burn of Cornea and Conjunctival Sac
940.3 - Acid Chemical Burn of Cornea and Conjunctival Sac
940.4 - Burn of Cornea and Conjunctival Sac, Other
940.5 - Burn with Resulting Rupture and Destruction of Eyeball
940.9 - Burn of Eye
941.02 - Burn of Eye with Other Parts of Face, Head, and Neck, Unspecified Degree
941.12 - First-degree Burn (Erythema) of Eye (with Other Parts of Face, Head, and Neck)
941.22 - Second-degree Burn, Blisters with Epidermal Loss of Eye (with Other Parts of Face, Head, and Neck)
941.32 - Third-degree Burn, Full-thickness Skin Loss of Eye, with Other Parts of Face, Head, and Neck
941.42 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Eye (with Other Parts of Face, Head, and Neck), without Mention of Loss of Body Part
941.52 - Deep Necrosis of Underlying Tissues (Deep Third Degree Burn) with Loss of a Body Part, Eye (with Other Parts of Face, Head, and Neck)

Overview

A burn of the eye (ocular burn) can involve the white of the eye (sclera), the mucous membrane that lines the eye (conjunctiva), the transparent outer wall of the eye (cornea), and the eyelid, as well as deeper structures inside the eye. The severity of the eye burn depends upon the cause of the injury, the duration of exposure to the agent, and the elapsed time before initiation of treatment. Ocular burns can be caused by chemical substances, thermal agents, or ultraviolet light.

Chemical eye burns are the most common type of ocular burn and result from exposure to caustic acid or alkaline substances. Acid burns are typically caused by compounds found in car batteries, refrigerants, cleaners, and industrial materials containing hydrochloric or hydrofluoric acid. Alkaline burns generally result from exposure to compounds found in fertilizers, lye, caustic potash, drainpipe cleaners, lime, whitewash, cement, sparklers, and road flares.

Eye tissue reacts to acid damage by forming a temporary protein barrier in the outer cell layer of the eye (corneal epithelium); this protein layer acts as a buffer, limiting further penetration by the chemical. The protein barrier does not form after exposure to alkaline chemicals, which are more destructive because they are able to penetrate into the eye faster, damaging eye tissue and rapidly producing inflammation.

Thermal or heat burns of the eye can occur in the workplace when sparks fly from welding equipment or when hot industrial materials such as molten plastics, metals, or hot gases accidentally penetrate the eye. Fires, lightning, hot liquids, explosions, electricity, and curling irons can also cause thermal eye burns. Thermal burns are generally mild, as exposure to extreme heat sources stimulates the blink reflex, allowing the eyelids to protect the eye surface. Both chemical and thermal burns may be associated with periocular, facial, or body burns.

Prolonged or unprotected exposure to bright sunlight, snow, high altitudes, or artificial ultraviolet light sources such as bright welding arcs, electric sparks, lasers, or tanning lamps can cause ultraviolet radiation eye burns. Medical phototherapy for treatment of psoriasis is another potential source of ultraviolet radiation. The US Food and Drug Administration warns that broken metal halide and mercury vapor light bulbs such as those used in gymnasiums and halogen desk lamps have been associated with ultraviolet radiation exposure that causes eye burns. With ultraviolet radiation, eye injury resulting from the burn is typically self-limited, but repeated exposure can lead to cataract formation.

Ocular burns from ionizing radiation occur when an individual is exposed to certain types of x-rays, gamma rays, radioisotopes, or nuclear explosions. Sudden exposure to ionizing radiation may cause immediate eye damage, including acute corneal erosions, perforation, and tissue death (radiation necrosis) in multiple layers of the eye, including the lens and retina. Delayed symptoms of exposure to ionizing radiation sources can develop at any time, ranging from a few days up to a year after exposure.

The vast majority of all eye injuries (90%) may be prevented through the use of equipment to protect the eyes and face (Melsaether).

Incidence and Prevalence: Eye burns are one of the most common eye emergencies worldwide, and represent 7% to 18% of eye trauma seen at emergency departments in the US (Melsaether). Of these, 84% are caused by chemical agents, and 16% are from thermal causes (i.e., hot liquids, gases, or molten metals) (Melsaether). Although the total incidence of eye burns from ultraviolet sources is unknown, ultraviolet light is the most common type of radiation eye injury (Brozen). Eye burns from ionizing radiation injury are relatively uncommon.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals whose work involves contact with corrosive chemicals, fire, hot liquids, hot gases, molten metals, electricity, welding equipment, lasers, x-rays, or radioisotopes are at increased risk for incurring ocular burns (Melsaether).

Men are at a slightly higher risk than women, possibly reflecting the greater number of men working in occupations involving chemical and thermal agents and also in jobs requiring outdoor activities or exposure to radioisotopes. Individuals with facial (especially nasal, sinus, and skin) cancers that require radiation therapy also are at increased risk. The average age of patients with eye burns is 36 years (Melsaether).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with chemical or thermal burns may complain of pain in the eye area or face, blurred vision, tearing, sensitivity to light (photophobia), and foreign body sensation. An individual with a chemical eye burn may report contact with an acid or alkaline substance. An individual injured by thermal exposure may report contact with flames, steam, electricity, lightning, or a hot appliance and may also have other burn or accident injuries.

An individual with an eye injury from ultraviolet radiation may mention exposure to a welding arc or sunlamp without the use of appropriate eye protection, or may recall prolonged outdoor exposure to sunlight reflected from concrete, water, or snow. Onset of symptoms usually occurs 8 to 24 hours after exposure and is characterized by pain, photophobia, and foreign body sensation.

Individuals with ionizing radiation eye injury typically report a recent history of radiation exposure.

Physical exam: Ocular burns are an ophthalmic emergency requiring immediate irrigation of the eye(s) with copious quantities of sterile saline (preferred) or cold tap water (if sterile saline is not available). Analgesics, topical anesthetics, and eyedrops to restrict movement of eye muscles (cycloplegics) are almost always necessary for patient comfort and to allow a thorough examination. A lighted instrument (ophthalmoscope) and special microscope (slit lamp) are used to view the cornea and interior eye structures.

Findings vary in severity, depending on the agent, concentration, mechanism of injury, duration of exposure, and delay in reaching medical attention. Physical examination may reveal corneal swelling (chemosis), redness (conjunctival injection), or blanching of the sclera due to blood vessel injury. With severe burns, there may be significant corneal edema, an opaque appearance to the cornea, and sloughing of the outer layer of cells on the surface of the eye (corneal epithelium). The eyelids may show signs of first-, second- or third-degree burns (redness in first-degree burns, blisters in second-degree burns, and a dark, leathery appearance in third-degree burns). If molten materials such as metal have penetrated the eye’s surface, eye perforation may have occurred.

Corneal injuries may be evident in cases of thermal eye damage. Signs of ultraviolet radiation eye burns include reddening of the eyelids (erythema), tearing, bloodshot eyes (conjunctival injection), corneal edema, and corneal epithelial irregularities and erosions. Ultraviolet waves are generally absorbed by the conjunctiva and cornea, leading to conjunctivitis and painful superficial keratitis. In severe cases, a diffuse haze may be seen over the cornea, and visual acuity may be temporarily reduced. Visual acuity may be reduced in all types of ocular burns.

After ionizing radiation eye burns, individuals may have conjunctival and corneal edema, dilation of small blood vessels within the eye (telangiectasias), atrophy of the corneal epithelium, retinal disease (retinopathy), hemorrhages, and protein leakage from the eye (exudation). Skin and other systemic changes may also be noted. Cataracts are a long-term consequence of excessive exposure to x-ray and nuclear radiation.

Tests: Following copious irrigation of the eye, a standard slit lamp examination using fluorescein dye should be performed to evaluate the eye structures. Areas that retain the dye may have epithelial injury or corneal ulceration. With ultraviolet radiation injury, slit lamp examination may reveal characteristic damage to the corneal epithelium such as conjunctivitis and keratitis. Examination may also include evaluation of the pressure inside the eye (intraocular pressure) with a tonometer. For chemical burns, the pH of the eye is checked to assess the adequacy of irrigation.

Source: Medical Disability Advisor



Treatment

Eye burns of any type are considered an emergency and require immediate treatment and referral to an ophthalmologist for follow-up care.

If massive chemical or thermal burns have been sustained, the individual may be in critical condition, requiring hospitalization and management of blood pressure, heart rate, blood circulation, and fluid balance (hemodynamic stability). If the injury involves chemical exposure, initial treatment consists of copious irrigation of the eye with sterile saline or lactated Ringer solution for at least 30 minutes to remove any chemical that may remain in contact with the eyelids or eyes. Although sterile saline is preferred, water may initially be used to flush the eye to help dilute the chemical. Analgesics, topical anesthetics, and cycloplegic agents are almost always necessary for patient comfort and to allow a thorough examination. Most emergency departments use a special device that looks like a very large contact lens with an irrigation port (Morgan lens) to irrigate the eye. With a chemical burn, the eye is irrigated for 30 minutes, allowed to equilibrate for 10 minutes, and then checked for pH. Irrigation should be continued until a neutral pH (7.3 to 7.7) is achieved, at which time the severity of the chemical injury and intraocular pressure can be assessed. Following irrigation of a thermal burn, the inner corners of the eyes (fornices) should be swept with a moistened cotton-tipped applicator for particulate matter such as ash or burned eyelashes.

Following irrigation of the affected eye and removal of any foreign bodies, treatment for chemical or thermal burns may involve the use of systemic or topical analgesics, topical steroids and antibiotics, lubricants to prevent adhesion of the eyelid to the eye, eyedrops to restrict movement of eye muscles (cycloplegics), and medications to reduce ocular pressure, if needed. If the eyelids have been burned, cool saline compresses are helpful for pain relief. Collagenase inhibitors and ascorbate are being used experimentally to treat corneal burns in some cases. Individuals should be monitored closely, daily if the burn is severe.

In severe cases of chemical or thermal injury, conjunctival adhesions may need to be broken down (lysed) using a glass rod. Devitalized tissue may require débridement, and the eyelid margins may need to be partially sutured together (tarsorrhaphy) to help prevent eyelid scarring and deformity. Use of topical steroids should be tapered off after 7 to 10 days to prevent corneal melting, which may necessitate a conjunctival graft. Steroids can also predispose individuals to eye infection. In individuals with only one injured eye, conjunctival transplantation from the opposite eye (conjunctival autograft) offers an alternative therapy that avoids both intraocular surgery and introduction of foreign tissue. Treatment may also be necessary to surgically repair the eyelid (blepharoplasty) or the cornea (corneal grafting, keratoplasty).

Ultraviolet radiation burns to the eye may be treated with topical nonsteroidal anti-inflammatory medication, cold compresses for comfort, rest, and oral nonsteroidal anti-inflammatory and analgesic medication if needed. An eye patch or dressing providing light pressure to the closed eye may be applied to help with pain relief; nonsteroidal anti-inflammatory eye drops may also be used for pain relief. Follow-up care should be provided within several days of injury to verify that the corneal epithelial defect has resolved.

If ionizing radiation eye burns have occurred, immediate removal of radioactive foreign bodies is needed with subsequent application of a bandage contact lens or tissue adhesive to protect the eyes. Severe cases with corneal perforation and / or radiation necrosis may require corneal transplantation (penetrating keratoplasty). Careful long-term follow-up is necessary to monitor acute changes in corneal and conjunctival epithelial erosions and to assess for late complications such as loss of corneal sensation, failure to heal, loss of corneal epithelium, and cataracts.

Tetanus immunization should be given to all individuals with ocular burns.

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Eye
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

The final outcome of an eye burn depends on the cause of the burn, the depth of the injury, which structure(s) of the eye were involved, whether other parts of the body were burned, and the development of complications. With eye burns of any type, close follow-up care is important during the first several weeks to prevent scarring and changes in interocular pressure that may prolong the clinical course.

Chemical eye burns can result in permanent damage such as blindness. Damage from an alkali burn may be severe if the chemical penetrates deep into eye structures, and loss of vision may result. Injury from acids may be limited to the cornea since acidic chemicals do not tend to penetrate through the cornea. The long-term consequences of chemical burns include angle-closure glaucoma, corneal scarring, and dry-eye syndrome (keratitis sicca).

A surgical procedure to reshape the eyelids (blepharoplasty) may improve the outcome following chemical or thermal injury. Small repairs to the eyelid usually have excellent results. The outcome is more variable with larger repairs or repairs of full thickness injury that may result in formation of thick, tight scar tissue (contracture). Contracture may result in lid retraction that prevents the eye from closing completely (lagophthalmos). Skin grafting may be necessary for extensive injuries.

Ocular burns from ultraviolet radiation usually heal without problems when treated with ophthalmic ointment and patching. Because these burns can be exquisitely painful, sterile topical anesthetics may be used initially. Full recovery is anticipated within 24 to 72 hours (Brozen). Although the prognosis for visual recovery is excellent, chronic ultraviolet exposure can lead to abnormal growth of conjunctival tissue and development of cataracts, which may impair vision.

Ionizing radiation eye burns heal poorly due to associated inflammation of the cornea (keratitis). The prognosis for corneal transplantation is poor in cases with severe late complications.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation may be necessary if the burn results in loss of vision. Rehabilitation programs provide therapy and training to those who are visually impaired. Occupational therapists may be involved in low-vision programs that address many facets of vision.

Visually impaired individuals may also use independent agencies that provide in-depth services, such as training in the use of a guide dog, a cane for mobility, and Braille instruction.

Vocational programs are available to assist individuals in developing job skills if alternative employment becomes necessary. Programs may last several weeks to months. Some vocational programs may be comprehensive residential programs.

Source: Medical Disability Advisor



Complications

For chemical burns, acute complications include an immediate rise in intraocular pressure. During the first 1 to 2 weeks after injury, corneal ulceration may develop. After the first 3 weeks, ocular surface problems may result from tear film abnormalities. Scar tissue may form within the cornea, conjunctiva, or between the eyeball and eyelid. Eyelid deformities may occur, including abnormal alignment of the eyelid in relation to the eye, as well as inward growth of the eyelashes. Other long-term consequences of chemical burns include angle-closure glaucoma, corneal scarring and keratitis sicca.

Complications from ultraviolet radiation injury may include cataract formation, retinal detachment, corneal burns, intraocular hemorrhage, and conjunctival squamous cell carcinoma. Late complications of exposure to ionizing radiation include loss of corneal sensation, loss of corneal epithelium, failure to heal, secondary microbial keratitis, vascularization, keratinization, and cataracts.

With any type of eye burn, breakdown of the corneal epithelium causes the eye to be more sensitive to infection, ulceration, and scarring.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Time off from work may be necessary while recovering from an ocular burn. If a severe burn occurs, visual impairment or complete loss of vision may result in some degree of disability. Depending on the visual impairment, visual aids may be needed. Individuals who develop cataracts following thermal or radiation injury may have decreased vision, and cataract extraction may become necessary in some cases. Individuals with ultraviolet or ionizing radiation injury may require time off work as a result of both discomfort and the necessary use of topical nonsteroidal anti-inflammatory analgesics during recovery.

Employer accommodations for individuals returning to work with impaired vision may include providing screen magnification software, increased operating system font size, and locator dots or print keyboard labels for those working on computers. Employers may consider reassignment of drivers from night shift to daylight hours, installing strategically placed cameras or rear vision cameras in vehicles, or reassignment to another position for those who drive. Accommodating individuals who work on the phone may involve placing large dots or tactile indicators on phone keypads or providing an optical magnifier ("Accommodation").

Regardless of the type of eye burn, individuals should be instructed in the correct use of eye and face personal protective equipment to avoid re-injury. Individuals who work outside or who are otherwise exposed to ultraviolet radiation must be reminded to use ultraviolet-protective eyewear, and those exposed to ionizing radiation must use safety goggles to provide adequate ocular protection.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual work in an industry where he or she is in contact with chemicals?
  • What type of burn did individual sustain (chemical, thermal, or radiation)?
  • Were the eyes examined for corneal injury?
  • Was fluorescein dye used to examine the eyes for epithelial injury?

Regarding treatment:

  • Was individual treated for a chemical or thermal burn?
  • Were the eyes immediately and thoroughly flushed?
  • Was an analgesic, an antibiotic, a cycloplegic, or a topical steroid used?
  • Was surgical intervention required?
  • Was individual treated for a ultraviolet or ionizing radiation injury?
  • Were ophthalmic nonsteroidal anti-inflammatory drops used?
  • Does individual have only one injured eye?
  • Was blepharoplasty necessary? Tarsorrhaphy?
  • Was conjunctival transplantation performed? Did it work?
  • Did individual receive a tetanus immunization?

Regarding prognosis:

  • Did the individual suffer any complications (chronic inflammation, adhesion formation, lid deformities, glaucoma, development of cataracts, scarring of the cornea and conjunctiva, intraocular hemorrhage, or associated trauma or burn injuries) that may affect the ability to recover and lengthen disability?
  • Did the individual suffer permanent visual impairment?
  • Did the individual participate in vision rehabilitation?

Source: Medical Disability Advisor



References

Cited

"Accommodation Ideas for Vision Impairments." Job Accommodation Network (JAN). U.S. Department of Health and Human Services. 8 Dec. 2008 <http://www.jan.wvu.edu/media/visi.htm>.

Melsaether, Cheri, and Carlo Rosen. "Burns, Ocular." eMedicine. Eds. Debra Slapper, et al. 1 Nov. 2007. Medscape. 8 Dec. 2008 <http://emedicine.com/emerg/topic736.htm>.

Randleman, James. "Chemical Eye Burns." eMedicine Health. Ed. . 10 Jan. 2007. WebMD, LLC. 8 Dec. 2008 <http://www.emedicinehealth.com/chemical_eye_burns/article_em.htm>.

General

Cheh, Anna, et al. "Burns, Ocular." eMedicine. Eds. Debra Slapper, et al. 2 Feb. 2006. Medscape. 7 Apr. 2006 <http://emedicine.com/emerg/topic736.htm>.

Trocme, S. D. "Cornea." Clinical Eye Atlas. Eds. D. H. Gold and R. A. Lewis. Chicago: AMA Press, 2002. 345-351.

Source: Medical Disability Advisor






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