What is the treatment for a 2-year-old who sprayed Easy Off (sodium hydroxide) into their eye?

Emergency Management of Sodium Hydroxide (Easy Off) Eye Exposure in a 2-Year-Old

Immediate Action Required

Begin continuous irrigation with copious amounts of tap water immediately for at least 15 minutes—this is the single most critical intervention to prevent permanent eye damage. 1, 2, 3

Step-by-Step Emergency Treatment

1. Immediate Irrigation (Start NOW)

• Use tap water directly from the faucet or any clean water source available—do not delay to find "better" solutions 1, 3, 4
• Continue irrigation for a minimum of 15 minutes continuously 1, 2, 3
• Hold the child's eyelids open during irrigation (you may need assistance with a 2-year-old) 2, 4
• Direct the water flow from the inner corner (near the nose) toward the outer corner to avoid contaminating the unaffected eye if only one eye was exposed 1, 3, 4

2. Special Considerations for Sodium Hydroxide (Alkali Burns)

• Sodium hydroxide is an alkali that causes particularly severe chemical burns and requires immediate decontamination 1
• If dry powder was visible before the spray, brush off any remaining powder before starting water irrigation to prevent further chemical reaction 1
• Alkali injuries penetrate deeper than acid injuries and cause more severe damage, making immediate irrigation even more critical 5

3. When to Stop Irrigation

• Continue irrigation until you can transport the child to an emergency department or ophthalmologist 3, 4
• Healthcare professionals will measure the pH of the eye to determine when irrigation can be stopped (normal pH is approximately 7.0-7.4) 3, 4
• Do not stop irrigation prematurely—15 minutes is the minimum, but longer may be needed for alkali exposures 1, 2

Urgent Medical Evaluation Required

Transport to Emergency Department

• After completing initial 15-minute irrigation, immediately transport the child to an emergency department or ophthalmologist 1, 3
• Continue irrigation during transport if possible 1
• Contact a regional poison center for additional guidance (they can provide chemical-specific recommendations) 1, 2, 3

What Healthcare Providers Will Do

• Measure tear pH to confirm adequate decontamination (irrigation continues until pH normalizes) 3, 4
• Examine the eye with fluorescein staining to assess corneal and conjunctival damage 4
• Arrange urgent ophthalmology consultation for comprehensive evaluation 4
• Apply topical anesthetics for comfort during examination 4

Subsequent Treatment (After Emergency Evaluation)

If Significant Irritation Persists

• Nonpreserved lubricant eye drops (hyaluronate or carmellose) every 2 hours 4
• Broad-spectrum topical antibiotic prophylaxis (e.g., moxifloxacin four times daily) if corneal staining or ulceration is present 4
• Topical corticosteroid drops (e.g., dexamethasone 0.1%) may be prescribed by the ophthalmologist to reduce inflammation, but only under specialist supervision 4

Daily Ophthalmology Follow-Up

• Daily ophthalmologic review is necessary for moderate to severe exposures to monitor for complications 4
• Gentle saline irrigation to remove debris should be performed by the ophthalmologist or specialist nurse 4

Critical Pitfalls to Avoid

• Never delay irrigation to transport the child—start water irrigation immediately at home before going to the hospital 3, 4
• Never delay irrigation to search for specialized solutions—tap water is effective and immediately available 1, 3, 4
• Avoid contaminating the unaffected eye during irrigation by directing flow appropriately 1, 3, 4
• Do not stop irrigation after only a few minutes—15 minutes minimum is required, and alkali burns often need longer 1, 2

Prognosis Considerations

• Early irrigation is associated with significantly reduced eye damage in both human and animal studies 1
• Delayed irrigation results in more full-thickness burns, longer hospital stays, and more complications 1
• Sodium hydroxide (alkali) injuries can cause severe and permanent damage including corneal scarring, limbal stem cell deficiency, and vision loss 5, 6
• The visual outcome depends critically on how quickly irrigation was started and how thoroughly it was performed 1, 5