From the Guidelines
For alkaline battery liquid exposure to the eye, immediately flush the eye with clean, lukewarm water or normal saline solution continuously for at least 15-20 minutes, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This initial step is crucial in reducing the severity of the chemical burn and preventing long-term vision damage.
Key Considerations
- Hold the eyelids open during irrigation to ensure thorough cleansing of the eye.
- Do not attempt to neutralize the chemical with another substance, as this can cause further damage.
- Do not rub the eye, as this may exacerbate the injury.
- If available, continue irrigation during transport to medical care.
Hospital Treatment
At the hospital, treatment may include:
- Additional irrigation to further cleanse the eye.
- pH testing of the eye to assess the severity of the chemical burn.
- Fluorescein staining to evaluate corneal damage.
- Topical antibiotics, such as erythromycin ointment, to prevent infection.
- Pain management with oral analgesics or topical anesthetics. Prompt treatment is essential, as chemical burns can rapidly cause permanent vision damage, with the severity depending on the type of battery fluid, concentration, and duration of exposure 1.
Ongoing Care
Ocular hygiene and daily ophthalmological review may be necessary during the acute illness, as outlined in the U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016 1. However, the primary focus should be on immediate irrigation and seeking medical attention, rather than delayed or specialized treatment.
Prioritizing Morbidity, Mortality, and Quality of Life
The recommended treatment prioritizes minimizing morbidity, mortality, and improving quality of life by promptly addressing the chemical burn and preventing long-term vision damage. This approach is supported by the most recent and highest-quality studies, including the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
From the Research
Treatment for Alkaline Battery Liquid Exposure to the Eye
- The recommended treatment for a patient with alkaline battery liquid exposure to the eye involves immediate and thorough irrigation of the eye with an aqueous solution, such as tap water, for at least 15-30 minutes 2.
- Warmed lactated Ringer's solution is theoretically preferable to normal saline as an ocular irrigant because it has a more physiologic pH and osmolarity 2.
- Prompt irrigation of the eyes with tap water immediately after alkali burns can significantly improve clinical and ocular outcomes 3.
- After irrigation, the patient should be treated with topical antibiotics, steroids, and a daily rodding procedure to prevent conjunctival adhesions, as well as undergo extensive irrigation and possible surgical intervention, such as amniotic membrane transplantation combined with conjunctival flap coverage 4, 5.
- Early detection and urgent removal of the battery are crucial in order to minimize exposure time and prevent significant ocular damage and visual compromise 4, 5.
Key Considerations
- The length of time the chemical remains in contact with the eye determines the severity of the injury, making immediate irrigation essential to minimize preventable loss of vision 6.
- Healthcare professionals should continuously update themselves about the latest evidence on the optimal methods of eye irrigation in enhancing patient outcomes 3.
- The type and severity of the ocular injury, causative chemicals, first-aid management, and time elapsed to eye irrigation are important factors to consider when treating a patient with alkaline battery liquid exposure to the eye 3.