Acute Ocular Manifestations after an Accidental Hydrofluoric Acid Release

Yong Joon Kim; Sang Hyouk Park; Kyung Seek Choi

doi:10.3341/jkos.2013.54.11.1663

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Kim, Park, and Choi: Acute Ocular Manifestations after an Accidental Hydrofluoric Acid Release

Original Article

J Korean Ophthalmol Soc 2013;54(11):1663-1668.

Published online: 2 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.11.1663

Acute Ocular Manifestations after an Accidental Hydrofluoric Acid Release

Yong Joon Kim, MD¹, Sang Hyouk Park, MD², Kyung Seek Choi, MD¹

¹Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea

²Department of Ophthalmology, Soonchunhyang University College of Medicine, Gumi, Korea

Address reprint requests to Kyung Seek Choi, MD, Department of Ophthalmology, Soonchunhyang University Seoul Hospital #59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea Tel: 82-2-709-9354, Fax: 82-2-710-3196 E-mail: ckseek@naver.com

Received 12 April 2013 Revised 20 June 2013 Accepted 9 September 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the ocular health of a community after an accidental release of hydrofluoric acid (HF).

Methods

The hospital records of 327 patients that were exposed to HF between Sep 9, 2012 and Oct 31, 2012 were reviewed. Demographic characteristics, subjective ocular symptoms, and the ophthalmologic examination results of the patients were analyzed retrospectively.

Results

Among the 327 patients, 203 patients (62.1%) were exposed to hydrofluoric acid (HF) within 1,000 m of the site of the accident. A total of 131 patients (40.1%) were exposed to HF over 3 days. The most frequently reported ocular symptoms after HF exposure were ocular pain (49.5%) and conjunctival hyperemia (37.9%). Conjunctival hyperemia (43.4%), corneal erosion (23.9%), conjunctiva papilla, and follicles (24.2% and 14.4%, respectively) were noted during ophthalmologic examinations, but 46.2% of patients were normal on examination. None of the patients had vision-threatening damages.

Conclusions

In this study, severe ocular surface changes, which can affect vision, were not identified. This result could be explained by the low atmospheric HF concentration after the accident.

Keywords: Chemical burn, Hydrofluoric acid, Ocular manifestation

References

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Figure 1.

Presentation time (in days) of cases to hospital after hydrofluoric acid release. Note that Day 2, 3, 4, and 6 were national holidays in the Republic of Korea.

Figure 2.

Number of visits to hospital for treatment.

Figure 3.

Mechanisms of chelation of calcium and magnesium with hydrofluoric acid.

Table 1.

Demographic characteristics of visited patients after accidental release of hydrofluoric acid

Variables
Number of patients	327
Sex ratio (male / female)	158 / 169
Age (years)	43.24 ± 13.96
Previous treatment	30 (9.2%)
Smoking
Current smoker	94 (28.7%)
Ex smoker	18 (5.5%)
No	215 (65.7%)
Systemic disease
Diabetes	12 (3.7%)
Hypertension	11 (3.4%)
Diabetes + Hypertension	3 (0.9%)
Asthma	3 (0.9%)
Tuberculosis	7 (2.1%)
Ophthalmologic history
Dry eye disease	5 (1.5%)
Corneal refractive surgery	2 (0.6%)
Accident to symptom (days)	3.1 ± 3.5

Table 2.

Distance from chemical plant and exposure time to hydrofluoric acid

Distance	N (%)	Exposure time	N (%)
≤50 m	25 (7.6)	≤6 hours	146 (44.6)
≤100 m	18 (5.5)	≤1 day	38 (11.6)
≤500 m	63 (19.3)	≤2 days	7 (2.1)
≤1,000 m	97 (29.7)	≤3 days	5 (1.5)
>1,000 m	124 (37.9)	>3 days	131 (40.1)

Table 3.

Ocular symptoms after exposure to hydrofluoric acid

Symptoms	Number of responses (multiple responses)
Ocular pain	162
Foreign body sensation	88
Itching sensation	33
Tearing	61
Hyperemia	124
Decreased vision	0

Table 4.

Ocular signs after exposure to hydrofluoric acid at first visit

Symptoms	Number
Normal exam	151
Corneal erosion	78
Corneal epithelial defect	1
Papilla	79
Follicle	47
Hyperemia	142
TBUT < 5 sec	38

TBUT = tear film break-up time.

Table 5.

Atmospheric hydrofluoric acid (HF) concentration around place of accident

Days after accident	HF concentration (ppm)
1	1
7	0.015
14	0.009
28	0.003

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