Management of Left Eye Pain Following Onion Exposure
For acute eye pain following onion exposure, immediate irrigation with cool artificial tears or saline solution is recommended, followed by continued lubrication with preservative-free artificial tears every 2-4 hours until symptoms resolve.
Initial Assessment
- The patient's symptoms of left eye pain after cutting onions with associated tearing and pain on blinking suggest a chemical irritation from onion vapors 1, 2
- No foreign body is visible and there is no visual impairment, which is reassuring 1
- Pain localized to the top of the left eyelid and occurring only with blinking and eye closure suggests irritation of the ocular surface 1
Treatment Approach
Immediate Management
- Perform thorough irrigation of the affected eye with cool artificial tears or saline solution to remove any remaining chemical irritants 3
- Cool compresses can provide symptomatic relief by reducing inflammation and irritation 1
- Instruct the patient to avoid rubbing the eye as this can worsen irritation and potentially cause epithelial damage 1
Ongoing Treatment
- Prescribe preservative-free artificial tears to be used frequently (every 2-4 hours) to lubricate the ocular surface and dilute any remaining irritants 1
- Refrigerated artificial tears may provide additional comfort due to the cooling sensation 1
- If symptoms are severe or persistent, a short course of topical non-steroidal anti-inflammatory drops may be considered 1
When to Consider Additional Treatment
- If symptoms persist beyond 48-72 hours or worsen, consider:
- Evaluation for possible corneal epithelial defect using fluorescein staining 1
- Assessment for development of chemical keratitis 1
- If significant inflammation is present, a brief course (1-2 weeks) of topical corticosteroids with a low side-effect profile may be considered under ophthalmologic supervision 1
Follow-up Recommendations
- Advise the patient to return if symptoms persist beyond 2-3 days 1
- Immediate return if there is worsening pain, decreased vision, or increased redness 1
- Follow-up should include visual acuity assessment and slit-lamp biomicroscopy if symptoms persist 1
Prevention Strategies
- Recommend protective eyewear when cutting strong onions in the future 1
- Cutting onions under running water or using a fan to blow vapors away can reduce exposure 2
- Refrigerating onions before cutting can reduce the release of irritating compounds 2
Important Considerations
- Avoid using topical anesthetics for pain relief as they can mask symptoms and potentially delay healing 1
- Be cautious with prolonged use of preserved eye drops as they can cause medicamentosa (toxic keratitis) 4
- If there is any suspicion of corneal involvement or infection, prompt ophthalmologic referral is recommended 1