Gasoline Eye Exposure: Immediate Management
Immediately irrigate the eyes with copious amounts of tap water for at least 15 minutes, starting at the scene of exposure without any delay. 1, 2, 3
Immediate Decontamination Protocol
Begin irrigation immediately at the scene—every second of delay increases the risk of permanent ocular damage from hydrocarbon exposure. 2, 3, 4
Primary Irrigation Technique
- Use tap water as the first-line irrigation fluid because it is readily available, safe, and effective for chemical eye exposures. 1, 2, 3, 4
- Continue irrigation for a minimum of 15 minutes, though some severe chemical exposures may require up to 30 minutes or even 2 hours of continuous irrigation. 1, 2, 4
- Direct the irrigation flow away from the unaffected eye to prevent cross-contamination and conversion of a unilateral injury to bilateral. 2, 3
- Assist the patient in keeping eyelids open during irrigation as many patients will require help maintaining adequate exposure of the ocular surface. 2, 3
Alternative Irrigation Solutions
- If immediately available at the scene, normal saline, Ringer's lactate solution, or commercial eye wash solutions are reasonable alternatives to tap water. 1, 2, 3
- Never delay irrigation to search for "better" solutions—immediate decontamination with whatever water is available takes absolute priority over finding specialized irrigation fluids. 2, 3
Critical Pitfalls to Avoid
Do not delay irrigation to transport the patient or search for specialized equipment—begin flushing immediately with whatever water source is available. 2, 3
Avoid contaminating the unaffected eye, other individuals, or surrounding areas during the irrigation process, as gasoline can cause injury to anyone exposed. 1, 2, 3
When to Stop Irrigation
Continue irrigation until a healthcare professional can evaluate the injury and confirm that the pH of the eye has returned to normal (physiologic pH of approximately 7.0-7.4). 2, 3
Post-Irrigation Management
Immediate Medical Evaluation
- Contact emergency medical services (EMS) or transport to an emergency department for formal ophthalmologic assessment after initial irrigation is complete. 1
- Contact regional poison control centers for expert guidance on management of severe hydrocarbon eye exposures. 1, 2
Supportive Ocular Care
- Apply nonpreserved lubricant eye drops (hyaluronate or carmellose) every 2 hours if significant irritation persists after irrigation. 2
- Arrange urgent ophthalmology consultation to assess for corneal epithelial damage, conjunctival injury, and potential long-term complications. 2
Infection Prophylaxis
- Initiate broad-spectrum topical antibiotic prophylaxis (such as moxifloxacin four times daily) if corneal fluorescein staining or epithelial defects are present on examination. 2
Anti-inflammatory Treatment
- Consider topical corticosteroid drops (dexamethasone 0.1%) only under direct ophthalmologic supervision to reduce ocular surface inflammation, but use with extreme caution as corticosteroids can mask signs of corneal infection. 2
Systemic Complications to Monitor
Be aware that gasoline absorption through ocular tissues can cause systemic toxicity, including pulmonary, cardiovascular, neurologic, renal, and hepatic complications, particularly with gasolines containing lead additives. 5
Monitor for signs of systemic hydrocarbon toxicity including respiratory distress, cardiac arrhythmias, altered mental status, and renal dysfunction. 5