Immediate Treatment for Chemical Eye Burns
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. 1
First-Line Emergency Management
Immediate Irrigation Protocol
- Start irrigation immediately without any delay—do not wait to transport the patient or search for "better" solutions 1, 2
- Use tap water as the preferred irrigation fluid for a minimum of 15 minutes continuously 1, 2
- If immediately available at the scene, normal saline, Ringer's lactate, or commercial eye wash solutions are reasonable alternatives, though tap water should never be delayed 1, 2
- Continue irrigation until a healthcare professional can assess the eye and confirm the pH has normalized (normal pH 7.0-7.4) 2, 3
Critical Technique Points
- Assist the patient in keeping eyelids open during irrigation—many patients will require help with this 1, 2
- Direct the irrigation flow away from the unaffected eye to prevent cross-contamination and converting a unilateral injury to bilateral 1, 2
- Remove contact lenses if present and any visible particulate matter 1
- For dry chemical exposures (sodium hydroxide, elemental sodium/potassium), brush off dry powder before beginning water irrigation to prevent exothermic reactions 1
Common Pitfalls to Avoid
Never delay irrigation for any reason—every second of contact time increases tissue damage and worsens prognosis 2, 3. The most common error is waiting to transport the patient or searching for specialized solutions when tap water is immediately available 2.
Avoid contaminating the unaffected eye, other individuals, or surrounding areas during decontamination 1, 3. Use personal protective equipment when providing care 1.
When to Escalate Care
Call EMS immediately for transport to emergency ophthalmology evaluation while continuing irrigation en route 1. All chemical eye burns require urgent ophthalmologic assessment regardless of initial appearance 4, 5.
For industrial chemical exposures or specific agents (hydrofluoric acid, phenol), contact regional poison control centers for specialized guidance while continuing irrigation 1, 2, 3.
Hospital-Based Management
Continued Decontamination
- Healthcare providers should measure tear film pH and continue irrigation until pH normalizes 2, 3
- Daily ophthalmologic examination is necessary during the acute phase 1, 2
Supportive Care After pH Normalization
- Apply nonpreserved ocular lubricants (hyaluronate or carmellose drops) every 2 hours to maintain corneal integrity 1, 2
- Consider topical corticosteroid drops (dexamethasone 0.1% twice daily) to reduce ocular surface inflammation, but only under ophthalmology supervision 1, 2
- Initiate broad-spectrum topical antibiotic prophylaxis (moxifloxacin four times daily) if corneal fluorescein staining or ulceration is present 1, 2
Daily Ocular Hygiene
- Perform mechanical removal of pseudomembranes and debris daily using saline irrigation under direct visualization by an ophthalmologist or trained nurse 2
- Use topical fluorescein to assess epithelial loss on cornea and conjunctiva 2
The severity of chemical eye burns correlates directly with the speed of initial irrigation—immediate copious water irrigation at the scene is more important than any subsequent hospital intervention for determining final visual outcome 4, 5, 6, 7.