Treatment of Arc Flash Injury to the Eyes
Immediate copious eye irrigation with tap water for at least 15-30 minutes is the critical first step for arc flash eye injuries, followed by urgent ophthalmology evaluation to assess for corneal burns, retinal damage, and potential vision-threatening complications. 1
Immediate First Aid Management
Begin irrigation immediately at the scene—do not delay for any reason. Arc flash injuries combine thermal, ultraviolet radiation, and potential chemical exposure (from vaporized metals), requiring aggressive decontamination. 1, 2
- Irrigate with copious amounts of tap water for 15-30 minutes minimum, extending up to 2 hours in cases of massive exposure 2
- Tap water is readily available, safe, and effective as the preferred irrigation fluid 2
- If available, warmed lactated Ringer's solution is theoretically superior due to more physiologic pH and osmolarity 2
- Do not rub the eyes during or after the injury 1
- Apply a protective eye shield (hard plastic shield, paper cup, or plastic cup taped over the eye) to prevent unintentional touching 1
Urgent Medical Evaluation
All arc flash eye injuries require immediate ophthalmology referral—this is an ophthalmologic emergency. 3
Critical Assessment Points:
- Test visual acuity immediately to establish baseline function 4
- Examine for signs of penetrating injury: irregular pupil, eye bleeding, or loss of vision after trauma 1
- Assess for corneal burns, which appear as yellow-white lesions on examination 5
- Evaluate for retinal damage, particularly macular injury from the intense light flash 5
- Screen for "arc eye" (ultraviolet keratitis), which typically presents 6-12 hours post-exposure 6
Hospital-Based Treatment
For Corneal Injury:
- Apply broad-spectrum topical antibiotic prophylaxis (e.g., moxifloxacin four times daily) 4, 7
- Topical NSAID (ketorolac) for pain, photophobia, and foreign body sensation 4, 7
- Oral acetaminophen or NSAIDs for additional pain relief 1, 4, 7
- Cycloplegic agents (cyclopentolate) to reduce ciliary spasm pain 4, 7
For Retinal Injury:
- Consider retrobulbar corticosteroid injection (40 mg triamcinolone acetonide) in acute stage for macular injury 5
- Serial optical coherence tomography (OCT) to monitor retinal layer damage 5
Common Pitfalls to Avoid
Do not delay irrigation to seek medical care—begin flushing immediately at the scene, then transport while continuing irrigation if possible. 1, 2
Do not patch the eye—this is contraindicated in corneal injuries and can worsen outcomes. 7
Do not assume minor symptoms mean minor injury—arc flash can cause delayed presentation of "arc eye" (ultraviolet keratitis) appearing hours after exposure, and retinal damage may not be immediately apparent. 6, 5
Do not discharge without ophthalmology evaluation—even seemingly minor exposures can result in vision-threatening complications including corneal scarring, retinal burns, and delayed vision loss. 3, 2