New York State Medical Treatment Guidelines for Thermal Burns in workers compensation patients

The guidelines provided by the New York State Workers Compensation Board offer general principles for managing Thermal Burns. These directives aim to assist healthcare professionals in determining appropriate strategies for diagnosing and addressing injuries caused by exposure to heat or extreme temperatures as part of a comprehensive care plan.

Healthcare practitioners specializing in Thermal Burns can rely on the guidance from the Workers Compensation Board to make well-informed decisions about the most suitable approaches for assessing and treating injuries resulting from thermal exposure in their patients.

It is crucial to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding the management of Thermal Burns should involve collaboration between the patient and their healthcare provider.

Thermal Burns

When it comes to immediate care for thermal eye injuries, giving the eye a thorough wash with a bunch of water or other watery solutions is seen as crucial for better outcomes. Now, ocular surface burns can happen when you’re hit with intense ultraviolet rays, especially from welding without the proper eye protection. It might also occur if you’re close to a welding operation without adequate eye gear.

The symptoms usually kick in a day after exposure, showing up as a red, painful, and irritated eye. The cornea often takes on a diffuse granular appearance. The story you tell about what happened and the initial checkup paint a pretty distinctive picture. When you look under a slit lamp, you’ll typically see that granular pattern, and interestingly, the upper and lower corneal margins often escape the damage since the eyelids shield those parts.



NSAID Ophthalmic Drops: Steer clear of using these drops for welder’s flash—it’s not recommended.

Eye Patching: Go for it—eye patching is recommended for dealing with welder’s flash.

Copious Irrigation: For thermal eye exposures, especially right after a welding mishap, it’s a smart move to give the eye a good wash. Don’t wait for symptoms to show up—start the rinse immediately. If you’re in a pinch, tap water works fine, especially in on-site situations. In-plant medical departments, clinics, and some facilities usually have irrigation bottles with solutions. While tap water does the job, if you’ve got options like normal saline or lactated Ringer’s solution, they’re better, but only if you can get them right away. Swap them in for tap water when possible.

To make the rinse more bearable, throw in a topical anesthetic if you’ve got one—it helps the eye handle the wash better.

Indications for Discontinuation: Only call it quits after a thorough rinse, using at least 500 mL to flush out the eye.

Irrigating Systems (e.g., Morgan Lens): Using irrigating systems like the Morgan Lens isn’t the way to go for thermal eye exposures—it’s not recommended.

Artificial Tears or Lubrication: For those dealing with thermal ocular burns, it’s a good call to use artificial tears or lubrication, but selectively. This is especially true for burns that are sizable and painful, particularly in cases where tearing isn’t cutting it.

NSAID Ophthalmic Drops: Steer clear of using NSAID drops for thermal ocular burns—it’s not recommended.

Eye Patching: Eye patching is recommended for treating moderate to severe thermal ocular burns. Go for it, especially when the burn is big enough to mess with vision and tearing isn’t enough.

Amniotic Membrane Transplantation with Medical Therapy: In rare cases, and in conjunction with medical therapy, using amniotic membrane transplantation is selectively recommended for treating thermal ocular burns, specifically those falling under Roper-Hall classification grades IIIV. The medical therapy includes a combo of prednisolone acetate, moxifloxacin, preservative-free lubricants, homatropine, and vitamin C for a specified duration.

Standalone Amniotic Membrane Transplantation for Acute Ocular Burns: Using standalone amniotic membrane transplantation for acute ocular burns isn’t recommended. There isn’t enough high-quality evidence to support this surgery on its own (check out AMT plus medications for more info).

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