From the Guidelines
Chemical eye injuries require immediate treatment with copious irrigation of clean water or saline solution for at least 15 minutes to prevent permanent damage. The most recent and highest quality study, 1, recommends decontamination by irrigation immediately after chemical exposure to the eyes, with a class 1 recommendation and level of evidence B-NR. This study suggests that unless otherwise recommended by local guidelines, irrigation with a copious amount of tap water for 15 minutes should be performed, with a class 1 recommendation and level of evidence C-LD.
Key Considerations
- Irrigation with normal saline, Ringer’s lactate solution, or a commercial eye wash solution is reasonable if immediately available, as stated in 1 with a class 2a recommendation and level of evidence B-NR.
- It is essential to avoid contaminating other individuals, areas, or the other eye with the caustic substance, as recommended in 1 with a class 1 recommendation and level of evidence C-EO.
- For industrial chemicals, it is reasonable to adhere to local guidelines or recommendations from a poison center, as stated in 1 with a class 2a recommendation and level of evidence C-LD.
Treatment Approach
- Irrigate the eye with copious amounts of clean water or saline solution for at least 15 minutes, holding the eyelids open to ensure thorough rinsing.
- After irrigation, apply artificial tears (preservative-free) every 1-2 hours to maintain lubrication.
- Topical antibiotics such as erythromycin ointment or moxifloxacin drops 4 times daily can help prevent infection.
- For pain management, oral analgesics like acetaminophen or ibuprofen can be used.
- Avoid topical anesthetics for prolonged use as they delay healing.
- Cycloplegic drops like cyclopentolate 1% twice daily may be prescribed to reduce pain from ciliary spasm.
- Severe chemical burns may require topical steroids like prednisolone acetate 1% 4-6 times daily to reduce inflammation, but these should only be used under medical supervision.
Importance of Prompt Medical Attention
Chemical eye injuries can lead to significant morbidity and mortality if not treated promptly, as stated in 1. Delayed treatment can result in corneal scarring, vision loss, or even blindness. Therefore, it is essential to seek medical attention immediately after a chemical eye injury.
From the Research
Treatment for Chemical Ocular Injuries
The treatment for chemical ocular injuries involves several steps, including:
- Immediate and thorough irrigation of the eye to remove the chemical substance 2, 3, 4, 5, 6
- Assessment of the severity of the injury, including the pH level of the substance and the extent of damage to the ocular surface epithelium, cornea, and anterior segment 2, 3, 5, 6
- Administration of topical cycloplegics and antibiotics to promote healing and prevent infection 3, 5
- Placement of a "bandage" contact lens to protect the corneal epithelium 3
- Surgical intervention, such as removal of necrotic corneal epithelium and conjunctiva, and limbal stem cell transplantation, may be necessary in severe cases 5
- Long-term care, including close monitoring and aggressive management, to promote ocular surface healing and prevent complications such as glaucoma and recurrent corneal ulcerations 3, 4, 5, 6
Key Considerations
- Prompt assessment and management of chemical eye injuries is crucial to prevent vision loss 2, 6
- The type and severity of the chemical injury will determine the appropriate treatment approach 2, 3, 5, 6
- Ophthalmologic consultation should be obtained early in the course of treatment, especially in severe cases 2, 3, 5, 6