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Ocular Injury After Thermal Blast
from a Propane Tank
Aruoriwo Oboh-Weilke, MD
Florian A. Weilke, MD
The authors have no financial interest in this subject matter
PURPOSE
We report a case of a patient who suffered
second degree burns to his face and presented
with significant foreign body deposits in his
conjunctiva, epithelial, sub-epithelial and stromal
layers of his cornea after a propane tank fire
related blast injury. The foreign bodies were of
various compositions. The patient achieved
excellent visual recovery after removal of the
superficially embedded foreign particles,
conservative management of the deeply
embedded materials and aggressive lubrication
of the ocular surface.
INTRODUCTION
Thermal blast injuries can cause damage to the
ocular and facial structures through several
mechanisms.
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
Potential damage from heat which can lead to 2nd and
3rd degree burns of the facial and eyelid structures.
Damage to the globe from flames is usually limited by
Bell’s phenomenon and rapid-reflex eyelid closure1 .
The other significant source of damage is from foreign
particles, propelled at a high velocity from the blast.
INTRODUCTION

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Some of these structures may remain
embedded in the cornea and result in a focal
inflammatory response known as ophthalmia
nodosum1. They may also remain inert or
migrate.
Embedded particles also pose an infection
risk.
CASE REPORT
A 43 year old male patient presented for a
cornea evaluation by a referring
ophthalmologist.
The patient stated that he attempted to light a
propane fired torch when uncontrolled
combustion occurred, most likely due to a leak
from the pressure regulator. The patient was
standing on a gravel roadway at the time of the
accident and his face was close to the torch at
the time of the injury.
CASE REPORT
He was evaluated and treated at the local
Emergency Room for his facial burns and
was seen by an ophthalmologist 24 hours
later.
The patient presented to me for a cornea
evaluation 72 hours after his injury.
On presentation he was complaining of
pain and severe foreign body sensation.
CASE REPORT
The exam revealed areas of erythema and blistering of
his face, upper and lower eyelids, singed eyebrows and
eyelashes.
BCVA was 20/150 OD and 20/200 OS
Pupils and IOPs were normal.
There was severe bilateral injection and chemosis, 360
degrees with multiple embedded foreign bodies in the
interpalpebral fissure nasally and temporally. Foreign
particles were also present in the corneal epithelium,
sub-epithelium and stroma. The foreign bodies were a
mixture of metal, gravel and some unidentified refractileappearing substance. They were too numerous to count
There were large epithelial defects bilaterally.
No foreign bodies were identified in the anterior
chamber, angle, lens or iris.
The posterior segment was unremarkable.
72hrs after injury
72 hrs after injury
RESULTS
Saline lavage of the cornea and the cul-de-sac
was performed. This removed some of the
debris that was not embedded in the ocular
surface.
After topical anesthesia was applied, using a
bent 25 gauge needle, the superficial particles
were extracted without any difficulties.
The patient was put on frequent preservativefree artificial tears, a cycloplegic and an
antibiotic/steroid ointment
RESULTS
4 weeks after the injury the patient’s VA without
correction was OD 20/20 , and OS 20/25+2.
The epithelial surface of both corneas was fairly
smooth. There were residual foreign particles in
the stroma without significant inflammation.
7 months after the injury, the patient’s VA
remains stable and the foreign materials in the
cornea appear inert and have not shown any
migration.
28 days after injury
28 days after injury
4 months after injury
DISCUSSION
Patients with severe blast injuries involving the facial
structures and ocular structures sometimes have a
delay in being referred to an ophthalmologist due to the
severity of the injury to other parts of their body.
Spencer et al report that prompt ophthalmologic
examination and the early use of prophylactic ocular
surface lubrication protect the cornea and decrease the
need for surgical intervention 2. In a review of blast
injuries to the eye by Zerihun, iris, conjunctival, corneal
foreign-bodies, and corneal/ scleral lacerations were
the most frequent types of injury seen 3
It is advisable to remove metallic foreign particles as
materials left in the cornea may lead to persistent
epithelial defects and inflammation1.
DISCUSSION
There are several tools that can be applied in
evaluating and treating these patients. Anterior
Segment Optical Coherence Tomography can be
useful in establishing the location and size of
these particles which in turn aids in
management and follow-up 4.
Patients with an irregular surface from corneal
foreign bodies can also be treated with
Phototherapeutic keratectomy 5
CONCLUSION

Thermal blast accidents can cause significant injuries
to the face and ocular structures. These injuries can
also lead to the deposition of foreign objects in
superficial and deep layers of the cornea. While it is
important to remove the superficial foreign bodies,
overly aggressive attempts at the removal of deep
foreign particles could lead to corneal perforations or
disruption of the corneal stroma. If there is no
resultant inflammation or infection, these deeply
embedded foreign bodies can be managed by close
observation as it is possible to obtain good visual
results without surgical intervention 1.
REFERENCES
1 External Disease and Cornea. Basic and Clinical
Science Course 2007-2008; 404-406
2 Ophthalmic plastic reconstructive surgery 2002
May;18(3):196-201.
3 Blast injuries of the eye. Zerihun N. Trop Doct.
1993 Apr;23(2):76-8.
4 Anterior segment optical coherence tomography in
eye injuries. Graefes Arch Clin Exp Ophthalmol. 2008
Sep 3.
5 Phototherapeutic keratectomy of diffuse corneal
foreign bodies caused by gunpowder explosion. Yan
Ke Xue Bao. 2005 Jun;21(2):70- 73
ACKNOWLEDGEMENT
I would like to thank Dr Kindy for my
participation in the care of this patient