When 'Chunambu' burns

It was the day after Pongal, and Karthik* had gone to his grandparents’ home in Ekkanampettai. While looking for puffed rice on a shelf, he stumbled upon a plastic packet of chunnambu (slaked lime), and, accidentally broke it open. The calcium hydroxide powder flew into his left eye, causing it to burn unbearably.

After being rushed from hospital to hospital, the six-year-old was finally brought to Sankara Nethralaya, where he underwent a series of procedures to save his eye. Seven years and about four surgeries later, Karthik can see from his damaged eye, but not completely.

Chunnambu, which is commonly used to spice up betel leaves or in whitewashing paint jobs, causes eye injuries in dozens of children every year, say doctors. “The problem is, it is often sold in thin plastic packets. Children are sent out to buy it for adults to use, or there is excess stored in the house,” said Geetha Iyer, senior consultant ophthalmologist at Sankara Nethralaya, where around 90 such cases are seen each year from across the country.

The damage caused to the eye can be extensive, often made worse by the fact that the patients come in several days after the injury. The alkali erodes the epithelial (surface) layer of the eye, and also damages the corneal stem cells.

“Corneal stem cells are needed for clarity of the cornea. Once this is damaged, it becomes difficult to restore vision,” said Dr. Iyer. In addition, the chunnmabu penetrates into the inner part of eye, sometimes causing glaucoma.

Doctors then have to battle on several fronts – to restore the surface of the eye, treat the cornea and also stop the glaucoma, said Bhaskar Srinivas, another ophthalmologist at the hospital. This can involve stem cell and cornea transplants, as well as other procedures to clean and treat the eye.

Nine-year-old Aamina* has missed a year of school after she slipped and fell while carrying a box of chunnambu in her home in Bihar. This is the third time she and her father, a driver, have visited Chennai and they may have to make a few more trips. “It is very difficult for us, as apart from the medical costs, we have travel, stay and food costs. I have taken a loan to meet the expenses,” said her father.

An injury such as this can derail a family, said Dr. Iyer. It can disrupt schooling, livelihoods and can have a lifelong psychosocial and cosmetic impact, she said.

“The worst part is, chemical injuries are almost always preventable,” said K. Namitha, director, Government Ophthalmic Hospital, Egmore, which sees around five such cases every month, some of them due to chunnambu. “No matter what we do, we can never give a child back the same vision she used to have,” she said.

Not selling chunnambu to children, ensuring the alkali is not sold in flimsy plastic packets and storing it well away from the reach of children is essential, doctors said.

“The problem is the lack of enough awareness about this issue. Parents have to realise how dangerous this chemical can be. Ensuring it is packed and sold in proper storage containers is also crucial,” said Dr. Srinivas.

(*Names changed)

What happens to the eye?

When calcium hydroxide gets into the eye, it penetrates further, causing damage. The longer the alkali stays in the eye, the more damage it causes

In most cases, it damages the corneal stem cells – essential for corneal clarity, and thereby vision. The extent of the damage can vary

It can also cause glaucoma

In some cases, it can cause permanent damage to the optic nerve

How is it treated?

Doctors first put the child under general anaesthesia and clean the eye out. Then, an amniotic membrane is put on the eye, to try and heal its surface

If the stem cells of one eye are damaged and the other eye is normal, a stem cell transplant is performed at a later stage

A corneal transplant may also be done, if required, after the stem cell transplant

If both eyes are damaged, doctors try using oral mucosal stem cells (from the cheek) to try and repair the cornea, but in this case, the options and outcomes are limited

What to do in case of an injury?

Wash the eye in water and keep washing it

Go to the nearest medical or ophthalmic facility immediately. Children often close their eyes due to the burning sensation, but the eye must be open and washed by medical personnel to get the chemical out

What are the other chemicals parents should store away from children?

Soap nut powder, bleaching powder, toilet cleaning acid and pesticides are other common causes of chemical eye injuries in children. All of these should be carefully stored, well away from the reach of children.

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Printable version | May 8, 2021 9:37:08 PM |

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