THE TREATMENT OF LIME BURNS OF THE CORNEA BY 10% NEUTRAL AMMONIUM TARTRATE

OF all burns of the cornea the one that is generally held to have the worst prognosis is that due to lime. For in this burn there are two factors which produce the resultant opacity. Not only does the caustic effect of the lime destroy the corneal tissue with resultant nebula, but the lime also combines with the tissues of the cornea to form particles of calcium carbonate. As time goes on this second element in the opacity tends if anything to increase. The nebula resulting from the actual burn can only be treated by surgical means-no chemical agents, as far as one is aware, have any effect on it. It is happily different with the second element in the opacity. As far back as 1905 zur Nedden recommended the use of 10 per cent. neutral ammonium tartrate for the removal of the calcium carbonate, and published successful cases. Since then up to the time I first started its use I find no mention of it in the literature and although it is recommended in various text-books, for instance those of Fuchs and Parsons, it has remained practically unknown.* The first case was seen at University College Hospital on February 4, 1924. The patient, H.F., a young man, aged 26 years, a plasterer by trade, had a severe burn of the cornea the result of cement containing lime entering his right eye four days before. admission. He was in much pain and the eye was lacrimating freely. There was much ciliary and conjunctival injection. The cornea stained with fluorescine almost over the whole of its extent and was typically cloudy in appearance. On examining it with a loupe the characteristic white spots of calcium carbonate could be seen. The eye was cocainized for ten minutes with 4 per cent. cocain (for the drug is at first far too painful without this preliminary treatment) and freshly prepared 10 per cent. neutral ammonium