What is the initial treatment for a patient with a superficial corneal burn?

Initial Treatment for Superficial Corneal Burns

Immediately irrigate the eye with large volumes of tap water for at least 15 minutes at the scene of injury, then apply topical antibiotics and ocular lubricants while arranging urgent ophthalmology evaluation. 1

Immediate Irrigation (First Priority)

• Begin irrigation immediately at the scene with tap water—do not delay to search for "better" solutions or transport the patient. 1
• Continue irrigation for a minimum of 15 minutes to minimize tissue damage. 1
• Tap water is the preferred irrigation fluid because it is readily available, safe, and effective for both chemical and thermal corneal burns. 2, 1
• If immediately available, normal saline or Ringer's lactate are reasonable alternatives, but do not delay irrigation to obtain them. 1
• Direct the irrigation flow away from the uninjured eye to avoid cross-contamination and converting a unilateral injury to bilateral. 1
• Assist the patient in keeping eyelids open during irrigation if needed. 1

Important Caveat on Irrigation Solutions

While tap water is universally recommended for immediate first aid, some research suggests isotonic saline may be less effective than buffered solutions for severe chemical burns. 3 However, the critical factor is immediate irrigation with whatever water is available—every second counts in preventing permanent damage. 1

Post-Irrigation Medical Management

Topical Antibiotics (Essential)

• Apply broad-spectrum topical antibiotic prophylaxis (moxifloxacin or levofloxacin four times daily) to prevent secondary bacterial keratitis, especially if any corneal epithelial defect is present. 2, 1
• Topical antibiotics following corneal trauma have been shown to prevent ulceration when started within 24 hours of injury. 2
• This strategy prevents both bacterial and fungal infection. 2

Ocular Lubrication

• Apply nonpreserved hyaluronate or carmellose eye drops every 2 hours if significant irritation persists. 1
• For thermal burns specifically, these lubricants maintain corneal epithelial integrity during healing. 1

Epithelial Debridement (For Thermal Burns)

• For thermal burns with damaged epithelium (such as from curling irons), gentle debridement of necrotic epithelium may be performed. 4
• Apply topical anesthetic (proparacaine or tetracaine) prior to debridement. 1
• Use topical fluorescein to assess the extent of epithelial loss. 1

Cycloplegia and Pain Management

• Consider cycloplegic agents for pain relief and to prevent synechiae formation in moderate to severe burns. 4

Critical Pitfalls to Avoid

• Never delay irrigation to transport the patient or search for specialized solutions. 1
• Do not patch the eye or use therapeutic contact lenses in the acute phase due to increased risk of secondary bacterial keratitis. 2
• Avoid contaminating the unaffected eye during irrigation. 1

Follow-Up Requirements

• Arrange urgent ophthalmology evaluation within 24 hours for all corneal burns to assess severity and guide ongoing management. 1
• Daily ophthalmologic review may be necessary for moderate to severe exposures. 1
• Most superficial thermal burns resolve completely within 48 hours with appropriate treatment. 4

Additional Considerations for Severe Burns

• For chemical burns, continue irrigation until pH returns to normal (requires healthcare professional assessment). 1
• Topical corticosteroids (dexamethasone 0.1%) may reduce inflammation in severe cases but should only be used under ophthalmologic supervision due to risk of masking corneal infection. 1
• Daily mechanical removal of pseudomembranes and debris may be needed in severe chemical burns. 1