Treatment for Pepper Spray Exposure to the Eyes
Immediate irrigation with copious amounts of tap water for 15 minutes should be performed as first-line treatment for pepper spray exposure to the eyes. 1
Immediate Management
- Begin decontamination by irrigation immediately after pepper spray exposure to minimize eye damage 1
- Use copious amounts of tap water for irrigation, continuing for 15 minutes 1
- When performing irrigation, avoid contaminating the unaffected eye, other individuals, or surrounding areas 1
- Some patients may need assistance keeping their eyelids open during irrigation 1
Alternative Irrigation Solutions
- If immediately available, eye irrigation with normal saline, Ringer's lactate solution, or a commercial eye wash solution is reasonable 1
- Commercial eye irrigation solutions may result in less severe eye injury compared to other irrigation fluids 1
- Balanced salt solutions may be more comfortable than other irrigation fluids 1
Clinical Assessment After Initial Irrigation
- Perform fluorescein staining and slit lamp or Wood's lamp examination to rule out corneal abrasions, which are not rare after pepper spray exposure 2
- Approximately 7% of pepper spray exposures result in symptoms severe enough to warrant medical evaluation 3
- The most common severe symptoms involve ocular (53.8%), respiratory (31.7%), and dermal (17.7%) organ systems 3
Secondary Treatment
- After initial irrigation, many patients require further care from an ophthalmologist and topical medication for symptom relief 4
- Be aware that despite immediate and intensive irrigation, some cases may still develop complete epithelial defects, limbal ischemia, or conjunctival chemosis 5
- Monitor for potential long-term complications such as neurotrophic superficial keratitis, reduced corneal sensitivity, and stromal scarring 5
- Consider evaluation for decreased tear production, which may occur after pepper spray exposure 6
Special Considerations
- Contact regional poison centers for expert advice on management of severe cases 1, 7
- Pepper spray (oleoresin capsicum) is an irritant that causes temporary effects but can lead to significant discomfort 1
- The risk of severe adverse health effects is approximately 1 in 15 exposed persons 3
- Protective eyewear significantly reduces the severity of injury when exposure occurs 6
Common Pitfalls to Avoid
- Delaying irrigation - immediate decontamination is critical to minimize tissue damage 1, 4
- Failing to examine for corneal abrasions, which occur in approximately 7% of pepper spray exposures 2
- Assuming all symptoms will resolve without treatment - some patients develop persistent ocular symptoms requiring medical evaluation 3
- Cross-contaminating the unaffected eye or other individuals during treatment 1