Immediate Treatment for Acute Eye Chemical Exposure
Begin copious irrigation with tap water immediately at the scene of exposure for a minimum of 15 minutes—this is the single most critical intervention to prevent permanent vision loss. 1
First-Line Emergency Management
Immediate Irrigation Protocol
Start irrigation within seconds of exposure using whatever clean water is immediately available—do not delay to search for "better" solutions like saline or commercial eyewash products. 1, 2
Irrigate continuously for at least 15 minutes with copious amounts of tap water, which is readily available, safe, and effective as the preferred irrigation fluid. 1, 2
Continue irrigation until a healthcare professional evaluates the injury and confirms the eye pH has returned to normal (typically 7.0-7.4). 2, 3
If immediately available at the scene, normal saline, Ringer's lactate solution, or commercial eye wash solutions are reasonable alternatives to tap water, but never delay irrigation to obtain these. 1, 2
Critical Technique Points
Direct the irrigation flow away from the unaffected eye to avoid cross-contaminating and converting a unilateral injury into bilateral damage. 2, 3
Assist the patient in keeping eyelids open during irrigation, as this may be difficult due to blepharospasm. 2
Remove all contaminated clothing and jewelry before or during irrigation to prevent trapping chemicals against surrounding skin. 1
Wear personal protective equipment when providing care to avoid contaminating yourself or other individuals with the caustic substance. 1
Special Chemical Considerations
Dry Chemical Powders
- For dry chemicals like sodium hydroxide, elemental sodium, or elemental potassium that react with water, brush off as much powder as possible first (dry decontamination) before beginning water irrigation. 1
Industrial or Severe Exposures
Contact regional poison centers immediately for chemical-specific treatment recommendations, especially for hydrofluoric acid, phenol, or other specialized chemicals that may require decontamination agents other than water. 1, 2, 4
Adhere to local industrial guidelines or Safety Data Sheets for specific chemical exposures. 1
Common Pitfalls to Avoid
Never delay irrigation to transport the patient to a medical facility—every second counts in preventing permanent corneal damage. 2, 4
Never apply neutralizing agents to chemical burns, as water irrigation remains the standard of care. 4
Never use bleach solutions for decontamination of acid burns, as this creates dangerous additional chemical reactions. 4
Do not give anything by mouth unless specifically advised by poison control or emergency medical personnel. 4
Post-Irrigation Medical Evaluation
Immediate Assessment
Healthcare providers should measure the pH of the eye to determine when irrigation can be stopped—this is the definitive endpoint. 2, 3
Arrange urgent ophthalmology consultation for initial examination to assess the extent of eyelid, conjunctival, and corneal involvement. 2
Use topical fluorescein eye drops to assess the extent of epithelial loss on both the cornea and conjunctiva. 2
Supportive Care After Irrigation
Apply nonpreserved ocular lubricants (hyaluronate or carmellose eye drops) every 2 hours if significant irritation persists. 1, 2
Daily ophthalmologic review is necessary during the acute illness for moderate to severe exposures. 1, 2
Maintain daily ocular hygiene with gentle saline irrigation to remove mucous or debris, performed by an ophthalmologist or specialist nurse. 2
Anti-inflammatory and Prophylactic Treatment
Topical corticosteroid drops (e.g., dexamethasone 0.1% twice daily) may reduce ocular surface damage when supervised by an ophthalmologist, though use with caution as they can mask signs of infection. 1, 2
Broad-spectrum topical antibiotic prophylaxis (e.g., moxifloxacin four times daily) is indicated if corneal fluorescein staining or frank ulceration is present. 1, 2
In unconscious patients or those with lagophthalmos, establish a moisture chamber with polyethylene film and long-lasting ophthalmic ointment to prevent corneal exposure and ulceration. 2