What is the treatment for irritant eye injection?

Treatment of Irritant Eye Injection

For acute irritant eye exposure, immediately irrigate with copious saline or preservative-free artificial tears, followed by topical anesthetic for symptom relief and short-term topical corticosteroids (dexamethasone 0.1% or prednisolone 0.5%) to prevent long-term complications including corneal neovascularization and blindness. 1

Immediate Management (First 2 Hours)

• Copious irrigation with saline solution or preservative-free artificial tears is the critical first step to dilute and remove the irritant from the ocular surface 2, 1

• Apply topical anesthetic (0.4% benoxinate hydrochloride or 0.5% tetracaine) immediately to prevent eye closure and allow continued irrigation 1

  • This prevents incapacitation and enables the patient to keep eyes open for adequate decontamination 1
  • Limit anesthetic use to the first 2 hours only to avoid corneal toxicity 1

• Cold compresses can provide additional symptomatic relief during the acute phase 2

Anti-Inflammatory Treatment (Days 1-6)

• Topical corticosteroids are essential to minimize inflammation and prevent long-term sequelae including corneal neovascularization 1

  • Use preservative-free dexamethasone 0.1% or prednisolone 0.5% four times daily for up to 6 days 3, 1
  • Research demonstrates that dexamethasone treatment significantly reduces initial inflammation and the extent and incidence of corneal neovascularization following irritant exposure 1

• For severe inflammation with risk of vision loss, corticosteroids may be extended beyond 1-2 weeks, but require baseline and periodic intraocular pressure monitoring plus pupillary dilation to evaluate for glaucoma and cataract formation 2, 4

Ongoing Supportive Care

• Continue preservative-free artificial tears frequently (at least 4 times daily) to maintain ocular surface hydration and facilitate healing 3, 2
• Refrigerated preservative-free tears provide additional cooling relief 2

Critical Monitoring and Follow-Up

• Examine within 24-48 hours to assess for corneal erosions, anterior chamber inflammation, and early signs of neovascularization 1
• Weekly follow-up for 4 weeks is necessary as irritant-induced damage can be long-lasting with significant pathological changes developing over weeks 1
• Monitor for corneal neovascularization starting as early as 1 week post-exposure 1
• If using corticosteroids beyond 2 weeks, measure intraocular pressure at each visit, as 30-50% of patients experience pressure elevation up to several months post-treatment 4

Important Pitfalls to Avoid

• Never delay irrigation - immediate decontamination is the most critical intervention to prevent permanent damage 1
• Avoid prolonged topical anesthetic use beyond the initial 2-hour period, as this causes corneal toxicity 1
• Do not use punctal plugs in irritant exposure, as they prevent flushing of inflammatory mediators from the ocular surface 2
• Avoid oral antihistamines as primary treatment, as they worsen dry eye syndrome and impair the tear film's protective barrier 2

When to Refer to Ophthalmology

• Emergency referral (within 24 hours) for severe inflammation, corneal erosions, or anterior chamber involvement 3, 1
• Urgent referral (within 4 weeks) if corneal neovascularization develops or vision changes occur 3
• Any case requiring corticosteroids beyond 2 weeks warrants ophthalmology co-management 3, 2