What is the treatment for bleach exposure to the eye?

Treatment for Bleach Exposure to the Eye

Begin immediate, copious irrigation with tap water for at least 15 minutes at the scene of exposure—this is the single most critical intervention to prevent permanent vision loss from bleach (sodium hypochlorite) chemical burns. 1, 2

Immediate First Aid (Pre-Hospital)

Start Irrigation Immediately

• Do not delay irrigation for any reason—every second counts in preventing irreversible corneal damage 1, 2
• Use tap water as the preferred irrigation fluid because it is readily available, safe, and effective 1, 3
• Continue irrigation for a minimum of 15 minutes, though up to 30 minutes to 2 hours may be necessary for severe exposures 3
• If immediately available, normal saline, Ringer's lactate, or commercial eye wash solutions are reasonable alternatives, but never delay treatment to search for these 1, 2

Critical Technique Points

• Direct the irrigation flow away from the unaffected eye to avoid converting a unilateral injury to bilateral 1, 2
• Assist the patient in keeping eyelids open during irrigation if needed 1, 2
• Remove contact lenses if present before or during irrigation 4

Hospital/Emergency Department Management

Continue Decontamination

• Continue irrigation until a healthcare professional confirms the pH of the eye has returned to normal (pH 7.0-7.4) 1, 2
• Consider using amphoteric, chelating solutions (such as Diphoterine®/Previn®) for secondary rinsing in the hospital setting, as this has been shown to significantly reduce lesion severity compared to isotonic saline 5
• Avoid using only isotonic saline solution for severe alkali burns, as research demonstrates it is ineffective at neutralizing intraocular pH even at high flow rates 6

Assessment and Monitoring

• Measure tear fluid pH immediately upon arrival—delays in measurement can artificially increase pH values 2
• Apply topical fluorescein to assess the extent of corneal and conjunctival epithelial loss 1
• Test visual acuity after irrigation is complete and the eye has rested 7

Post-Decontamination Treatment

Supportive Care

• Apply nonpreserved lubricant eye drops (hyaluronate or carmellose) every 2 hours if significant irritation persists 1
• Maintain daily ocular hygiene with gentle saline irrigation to remove mucous or debris 1

Infection Prophylaxis

• Initiate broad-spectrum topical antibiotic prophylaxis (moxifloxacin or levofloxacin four times daily) if corneal fluorescein staining or frank ulceration is present 1

Anti-Inflammatory Treatment

• Topical corticosteroid drops (dexamethasone 0.1%) may reduce ocular surface damage when supervised by an ophthalmologist 1
• Use corticosteroids with extreme caution as they can mask signs of corneal infection 1

Ophthalmology Referral

• Arrange urgent ophthalmology consultation for all but the most trivial chemical burns 3
• Daily ophthalmologic review may be necessary for moderate to severe exposures 1
• Contact regional poison centers for expert advice on management of severe cases 8, 1

Common Pitfalls to Avoid

• Never delay irrigation to transport the patient or search for "better" solutions—immediate tap water irrigation at the scene is more important than waiting for sterile solutions 1, 2
• Do not cross-contaminate the unaffected eye, other individuals, or surrounding areas during irrigation 8, 1
• Do not rely solely on isotonic saline for severe alkali burns, as it is ineffective at neutralizing intraocular pH 6
• Do not use corticosteroids without ophthalmology supervision due to infection risk 1

Long-Term Considerations

Bleach (sodium hypochlorite) is an alkali that can cause severe, progressive tissue damage. The length of time the chemical remains in contact with the eye determines injury severity 4. Alkali injuries generally result in more severe outcomes than acid injuries 3. Long-term complications can include corneal scarring, vision loss, and in extreme cases, blindness 4, 7.