Saline Eyewash Directions
For chemical or toxic eye exposures, immediately irrigate with copious amounts of tap water for at least 15 minutes—saline is acceptable if tap water is unavailable, but do not delay irrigation to search for it. 1, 2
Immediate Irrigation Protocol
First-Line Approach
- Begin irrigation immediately at the scene of exposure with whatever clean water is available—every second of delay increases tissue damage 2, 3, 4
- Use continuous, large volumes of tap water as the preferred irrigation fluid because it is readily available, safe, and effective 1, 2, 5
- Continue irrigation for at least 15 minutes minimum, or until advanced medical care arrives and confirms the eye pH has returned to normal 1, 2
When Saline May Be Used
- If immediately available, normal saline, Ringer's lactate solution, or commercial eye wash solutions are reasonable alternatives to tap water 1, 2
- However, do not delay irrigation to transport the patient or search for saline—tap water should be started immediately 2, 3
- Interestingly, animal studies show tap water may actually be superior to saline for alkaline burns, as saline resulted in higher pH levels in the anterior chamber compared to tap water 1
Critical Technique Points
Proper Irrigation Method
- Direct the irrigation flow away from the unaffected eye to avoid cross-contamination and converting a unilateral injury to bilateral 6, 2, 3
- Some patients will require assistance keeping their eyelids open during the irrigation process 6, 2
- Use a continuous stream rather than intermittent splashing—this can be accomplished with a 1-liter bag of saline attached to IV tubing with a 16-gauge catheter if in a medical setting 7
- Avoid contaminating other individuals or surrounding areas with the caustic substance during irrigation 6, 3
Duration and Endpoint
- The definitive endpoint for stopping irrigation is when a healthcare professional evaluates the injury and confirms the eye pH has returned to normal 1, 2, 3
- For severe alkali burns, pH may remain elevated even after 15 minutes of irrigation with 1.5 liters of fluid, necessitating continued treatment 1
- In some cases of massive exposure, irrigation may need to continue for up to 2 hours 5
When to Escalate Care
- Call 9-1-1 or contact the local poison control center immediately for all chemical eye injuries while continuing irrigation 1, 2
- Arrange for immediate ophthalmologic evaluation for all but the most trivial chemical exposures 5
- Healthcare providers should perform pH testing of the eye to determine when irrigation can safely be stopped 2, 3
Common Pitfalls to Avoid
- Never delay irrigation to search for "better" solutions like saline or commercial products—immediate decontamination with tap water is critical 2, 3
- Do not stop irrigation prematurely—15 minutes is the minimum, and severe burns require longer treatment until pH normalizes 1, 2
- Avoid cross-contaminating the unaffected eye, which can double the severity of injury 6, 2
- Do not underestimate the urgency—clinical outcome is directly related to how quickly treatment begins 4