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Original Investigation
October 2016

Epidemiologic Trends of Chemical Ocular Burns in the United States

Author Affiliations
  • 1Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 3Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins Hospital, Baltimore, Maryland
  • 4currently a medical student, University of Iowa Carver College of Medicine, Iowa City
  • 5Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
JAMA Ophthalmol. 2016;134(10):1119-1124. doi:10.1001/jamaophthalmol.2016.2645
Key Points

Question  What populations are at highest risk for ocular chemical burns?

Findings  In a cross-sectional analysis of the US Nationwide Emergency Department Sample, children aged 1 to 2 years are at a significantly higher risk for ocular chemical burns than any other group. In general, ocular chemical burn injuries are most common among individuals aged between 18 and 64 years (73.2%).

Meaning  Children aged 1 to 2 years are at much higher risk for an ocular chemical burn than previously recognized, and effective prevention efforts must include considerations for this age group.


Importance  Determining the national epidemiologic trends of chemical ocular burns can assist physicians and policy makers in appropriate allocation of resources for treatment and prevention.

Objective  To describe the epidemiologic trends and risk factors for chemical burns of the eye.

Design, Setting, and Participants  Between August 1, 2015, and April 25, 2016, data from the Nationwide Emergency Department Sample were analyzed from January 1, 2010, through December 31, 2013. A sample of 900 emergency departments (EDs) across the United States was used. Patients presenting to EDs with a diagnosis of alkali or acid ocular burn, chemical conjunctivitis, or a combination of nonspecific ocular chemical burn and chemical poisoning or toxic effects were eligible for inclusion. Injured patients’ age, sex, primary health care insurance, income quartile, and other demographics were described. A subset consisting of those injuries identified as alkaline or acidic burns was further characterized.

Main Outcomes and Measures  Age-specific rates of ED presentation for chemical ocular burn injuries, independent factors associated with all, alkali, and acid injuries, and total ED-associated charges.

Results  From January 1, 2010, through December 31, 2013, a total of 144 149 chemical ocular burns were diagnosed at EDs nationwide. Men represented 56.6% of all cases (n = 81 496). Median age was 32 years, with female patients presenting at a younger age than male patients (median of 32 vs 34 years; P < .001). Injury rates were highest among children aged 1 to 2 years (28.61 and 23.49 injuries per 100 000 population, respectively). Adults aged between 18 and 64 years also have these injuries at an increased rate, although this rate was half that of infants (mean, 13.28 per 100 000 population). Alkali injuries were more common than acid injuries (53.6% [n = 9137; 95% CI, 51.6%-56.0%] vs 46.4% [n = 7909; 95% CI, 44.0%-48.9%]), and all chemical eye injuries most commonly occur in residential locations (10.3% [n = 14 772]; 95% CI, 9.6%-10.9%) and among individuals in the first and second (lowest and second-lowest) income quartiles (≤$48 749) (56.0% [n = 80 691]; 95% CI, 54.4%-57.7%). Injuries most commonly occurred among those who had private health care insurance (31.9% [n = 45 900]; 95% CI, 30.9%-32.9%), and occurred more in the South (36.8% [n = 53 008]; 95% CI, 34.6%-39.1%). Emergency department charges due to these injuries totaled $106.7 million.

Conclusions and Relevance  Young children represent the single highest-risk group for ocular chemical injuries. Education and other interventions concerned with preventing these injuries will be most effective if used accordingly.