What fluids are recommended for ocular (eye) irrigation?

From the Guidelines

For ocular irrigation, the most recommended fluid is normal saline, but according to the most recent guidelines, irrigation with a copious amount of tap water for 15 minutes is also acceptable if normal saline or other recommended solutions are not immediately available. This approach is based on the latest recommendations from the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The key is to perform decontamination by irrigation immediately after chemical exposure to the eyes.

When considering the options for ocular irrigation, it's crucial to prioritize the most readily available and effective solution. Normal saline (0.9% sodium chloride) is typically the preferred choice due to its isotonic nature, which minimizes disruption to the ocular tissues. However, in situations where normal saline is not available, irrigation with tap water for 15 minutes is recommended as a reasonable alternative 1. Lactated Ringer's solution or commercial eye wash solutions are also acceptable if immediately available 1.

The method of irrigation is also important. The fluid should be directed from the inner to the outer canthus to prevent contamination of the unaffected eye and the nasolacrimal system. For chemical exposures, immediate irrigation should continue for at least 15 minutes using a copious amount of fluid, as recommended by the guidelines 1. The use of sterile solutions is preferred, especially in cases of corneal abrasions or post-eye surgery, to minimize the risk of infection.

It's also worth noting that the pH of the irrigation solution should be as close to neutral (around 7.4) as possible to avoid further irritation to the ocular surface. Solutions containing preservatives or medications should be avoided unless specifically indicated for the patient's condition.

In emergency situations involving chemical eye injuries, it is reasonable to follow local guidelines or recommendations from a poison center 1, as the specific treatment may depend on the type of chemical involved. The importance of immediate evaluation by a healthcare professional after a chemical eye injury cannot be overstated, as emphasized in previous guidelines 1.

From the Research

Ocular Irrigation Fluids

• The choice of ocular irrigation fluid is crucial in managing chemical eye injuries, with various options available, including normal saline, lactated Ringer's solution, and balanced salt solutions like BSS Plus 2, 3, 4.
• Studies have compared the effectiveness and tolerability of these solutions, with some finding that BSS Plus is superior to normal saline and lactated Ringer's solution in terms of patient comfort and ocular outcomes 2, 4.
• The pH of the irrigation solution also plays a significant role in its tolerability, with solutions having a pH closer to the natural pH of the eye being better tolerated 3.
• In addition to the type of solution, the method of irrigation, including the use of therapeutic lenses like the Morgan therapeutic lens, can also impact patient comfort and ocular outcomes 5.

Comparison of Irrigation Solutions

• Normal saline is a commonly used irrigation solution, but it may not be the most effective or comfortable option for patients, particularly those with chemical eye injuries 2, 3.
• Lactated Ringer's solution has been found to be more comfortable for patients when used with the Morgan therapeutic lens, and it may be a good alternative to normal saline 5.
• BSS Plus has been shown to be superior to normal saline and lactated Ringer's solution in terms of patient comfort and ocular outcomes, making it a good option for ocular irrigation 2, 4.
• Other solutions, such as diphoterine, have also been found to be effective in managing ocular chemical burns, and may be considered as an alternative to traditional irrigation solutions 4.

Considerations for Ocular Irrigation

• The choice of irrigation solution should be based on the individual patient's needs and the specific characteristics of the solution, including its pH and composition 3, 5.
• The use of therapeutic lenses, like the Morgan therapeutic lens, can impact patient comfort and ocular outcomes, and should be considered when selecting an irrigation solution 5.
• The effectiveness of irrigation solutions in eradicating bacteria and promoting healing should also be considered, with some solutions, like povidone-iodine, showing promise in this area 6.