How to Triage Chemical Injuries of the Eye

Chemical Burn (Bleach from Splash) A long term patient calls your office. He is in a panic because he splashed a liquid fertilizer in his eye. He is in pain and can barely open his eye.  He is counting on you to make sound decision to save his eye sight.

A True Eye Emergency  Ocular chemical burns are true eye emergencies and can cause irreversible damage to the eye and adnexa if appropriate treatment is not initiated quickly.  Some chemicals can penetrate the eye in as little as five minutes. Time is of the essence!

About Chemicals  Chemicals can be solid, liquid or  gas and can be alkali or acidic. Alkali agents such as ammonia, lye, firework sparklers, lime and cement have a high pH (> 10).    Acidic agents such as bleach, battery acid, vinegar, swimming pool cleaners and hydrofluoric acid which is found in refrigerants, fluorescent bulbs and other products have a low pH (< 4). 

First Things First   When a patient has a chemical injury start irrigation Immediately! Ask the patient what chemical the eye was exposed to, the time and what first aid has been provided. ***Start irrigation NOW! DON’T WAIT!***  The eye should be copiously irrigation with water, ideally at the location where the exposure occurred.  if the patient is at home, they can get in the shower, at work use an eyewash station and outdoors use a garden hose. In the office use an eyewash station, a Morgan lens or a nasal cannula positioned and taped to the bridge of the nose.

If irrigation begins immediately, normal pH is restored to the eye typically after thirty minutes (3 liters) of continuous irrigation, however if irrigation is delayed, irrigation volumes may need to exceed 20  liters before normal pH is restored to the eye as measured by pH paper.

References:

http://www.reviewofoptometry.com/content/d/cornea/c/52907/

http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/154975/eem_education_session4.pdf