What is the treatment for a patient with chemical eye contact with muriatic acid?

Chemical Eye Exposure to Muriatic Acid: Treatment Protocol

Immediately irrigate the affected eye with copious amounts of tap water for a minimum of 15 minutes, starting at the scene without any delay. 1

Immediate First Aid (Within Seconds of Exposure)

• Begin irrigation instantly at the site of exposure—do not waste time searching for "better" solutions or transporting the patient first 1, 2
• Use tap water as the primary irrigation fluid because it is readily available, safe, and effective for acid burns 1, 2
• Continue irrigation for at least 15 minutes continuously 1, 2
• Assist the patient in keeping eyelids open during the entire irrigation process, as many patients will need help with this 1, 2
• Direct the flow of water away from the unaffected eye to prevent cross-contamination 1, 2
• Remove all contaminated clothing immediately to prevent ongoing exposure 1, 3

Why This Matters

Muriatic acid (hydrochloric acid) causes tissue damage that worsens with every second of contact—the extent of injury is directly related to exposure duration, making rapid removal of the caustic agent the single most critical factor determining visual outcome 1, 2, 4. Early irrigation is associated with reduced eye damage in both human observational and animal experimental studies 1.

Alternative Irrigation Solutions (If Immediately Available)

• Normal saline, Ringer's lactate solution, or commercial eye wash solutions are reasonable alternatives if present at the scene 1, 2
• Commercial eye irrigation solutions may result in less severe-grade eye injury compared to other fluids 1
• Balanced salt solutions may provide more comfort during irrigation 1
• However, do not delay irrigation to search for these alternatives—tap water is effective and every second counts 2, 3

Emergency Medical Services Activation

• Call 9-1-1 or activate EMS immediately after starting irrigation 3
• Contact the regional poison control center (1-800-222-1222 in the US) for chemical-specific treatment recommendations 1, 2
• Provide information about the product name (muriatic acid), concentration if known, time of exposure, and extent of contact 1, 3

Hospital-Based Management

Continued Decontamination

• Continue irrigation in the emergency department until the pH of the eye returns to normal (pH 7.0-7.4) 2, 3
• Healthcare providers should assess ocular pH to determine when irrigation can be stopped 2

Ophthalmologic Assessment

• Arrange urgent ophthalmology consultation for initial examination to assess 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
• Grade the severity of limbal stem cell injury by assessing the degree of limbal, conjunctival, and scleral ischemia 5

Supportive Care

• Apply nonpreserved ocular lubricants (hyaluronate or carmellose eye drops) every 2 hours to maintain corneal epithelial integrity 1, 2
• Perform daily ocular hygiene with gentle saline irrigation to remove mucous or debris, ideally by an ophthalmologist or ophthalmically trained nurse 1, 2
• Mechanical removal of pseudomembranes and debris should be performed daily during the acute phase 2

Anti-Inflammatory Treatment

• Apply topical corticosteroid drops (e.g., nonpreserved dexamethasone 0.1% twice daily) under ophthalmologic supervision to reduce ocular surface damage 1, 2
• Use corticosteroids with caution as they can mask signs of corneal infection 2

Infection Prophylaxis

• Initiate broad-spectrum topical antibiotic prophylaxis (e.g., moxifloxacin or levofloxacin four times daily) if corneal fluorescein staining or frank ulceration is present 1, 2

Ongoing Monitoring

• Daily ophthalmological review is necessary during the acute illness for moderate to severe exposures 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 2

Critical Pitfalls to Avoid

• Never delay irrigation to transport the patient or search for specialized solutions—every second of contact increases permanent damage 2, 3
• Never attempt to neutralize the acid with alkaline solutions—water irrigation is the standard of care 3
• Never cross-contaminate the unaffected eye during treatment, which can convert a unilateral injury to bilateral 1, 2
• Never give anything by mouth unless advised by poison control or emergency medical personnel 1, 3
• Do not underestimate the severity of muriatic acid burns—concentrated acids can cause devastating fourth-degree burns requiring operative intervention 6

Special Considerations for Muriatic Acid

Muriatic acid at typical commercial concentrations (31.45%) can cause severe tissue damage, particularly when combined with other chemicals or when removal is delayed 6. The rubber-based nature of some pool products can make decontamination more difficult, emphasizing the critical importance of immediate and prolonged irrigation 6.