What is the treatment for chemical mace (oleoresin capsicum) exposure to the face?

Treatment for Mace (Oleoresin Capsicum) Exposure to the Face

Immediately irrigate the face and eyes with copious amounts of tap water, as this is the primary and most effective decontamination method for chemical exposures including oleoresin capsicum (pepper spray/mace). 1

Immediate Decontamination (First Priority)

Eye Irrigation

• Begin immediate and copious irrigation of the eyes with large amounts of tap water 1
• Tap water is as effective as saline and is the most readily available decontamination agent 1
• Continue irrigation for at least 15-20 minutes to physically remove the capsaicin from ocular surfaces 2
• Remove contact lenses if present before irrigation 2

Facial Skin Decontamination

• Brush off any visible powder or residue with a gloved hand or cloth before applying water 1
• Irrigate the entire exposed facial area with copious amounts of water 1, 3
• Soap and water can be used after initial water irrigation for more thorough decontamination 3, 2
• Remove all contaminated clothing to prevent re-exposure 1

Symptom Management

Ocular Symptoms (Most Common)

• Topical anesthetic (proparacaine 0.5%) is effective for severe eye pain and provided relief in 16 of 29 exposed individuals 4
• Expect intense burning, tearing, blepharospasm, and conjunctival injection that typically improves within 1 hour 4, 2
• Corneal sensitivity is dramatically reduced immediately after exposure but returns to normal within 1 week 4
• Examine for corneal abrasions with fluorescein staining, as punctate epithelial erosions occur in approximately 21% of cases 4, 5

Dermatological Symptoms

• Apply cool compresses to affected facial areas for symptomatic relief 2
• Expect erythema, burning sensation, and hyperalgesia that are self-limited 2, 5
• Avoid touching or rubbing the face, as this spreads the irritant 2

Respiratory Symptoms

• Monitor for dyspnea, chest tightness, or bronchospasm, though these are uncommon 2, 5
• Most respiratory symptoms are transient and resolve with supportive care 5
• Activate EMS immediately if the patient exhibits difficulty breathing, altered mental status, or seizures 1

Important Clinical Considerations

What NOT to Do

• Do NOT administer anything by mouth (water, milk, or activated charcoal) unless directed by poison control 1
• Do NOT use topical NSAIDs (flurbiprofen) for eye pain, as they are ineffective for capsaicin exposure 4
• Do NOT delay irrigation—effectiveness of decontamination decreases rapidly with time 3

Expected Clinical Course

• Symptoms are almost instantaneous upon exposure 2
• Peak symptoms occur within 10 minutes 4, 2
• Most symptoms significantly improve within 1 hour 4, 5
• Complete resolution typically occurs within 24 hours to 1 week 4, 2
• Hospitalization is rarely required, with none needed in a series of 81 emergency department patients 5

When to Seek Advanced Care

• Persistent severe eye pain beyond 1-2 hours despite treatment 4
• Visual acuity changes that do not resolve 4
• Evidence of corneal abrasion requiring ophthalmologic follow-up 5
• Respiratory distress or bronchospasm 2, 5
• Symptoms in high-risk individuals (asthmatics, contact lens wearers) 2

Common Pitfalls to Avoid

• Inadequate irrigation volume or duration—use truly copious amounts of water for at least 15-20 minutes 1, 2
• Cross-contamination—avoid touching eyes or face with contaminated hands, and properly dispose of contaminated clothing 1, 2
• Premature reassurance—while rarely life-threatening, corneal abrasions occur in a significant minority and require proper evaluation 4, 5