Chemical Eye Injury

Chemical Eye Injury
1. Eye Injury via strong acids or bases in liquid, powder or gas form

Strong acids or bases
1. Alkali are more common in home cleansers
2. Alkali penetrate the eye surface rapidly
Longer duration of exposure
Most eye damaging agents
1. Strong bases/alkali such as bleach (pH > 10, associated with worse outcomes)
2. Hydrofluoric Acid (semiconductor production)

Damage to Conjunctiva and Cornea
Ischemia may result from adjacent injury to Conjunctival or Scleral vessels
1. May cause Corneal scarring and opacification

Eyelid burn
1. Reflex blepharospasm may interfere with exam
Conjunctival or Corneal color
1. Red Eye with Conjunctival injection (most common)
2. Corneal Epithelium disruption (Fluorescein stain uptake)
3. White eye (Corneal clouding) suggests severe Eye Injury with ischemia

Litmus paper (acid-base pH paper) applied to Conjunctival fornix (where bulbar and palpebral Conjunctiva meet)
Visual Acuity
Observe eye appearance for injury
1. Corneal Opacification or clouding
2. Conjunctival injection
Observe for Eyelid Swelling or Burn Injury
Fluorescein stain for Corneal epithelial defect

See Eye Irrigation
Ocular Emergency requiring immediate management
Apply Topical Anesthetic to eye or add Lidocaine to saline irrigation bag (see Eye Irrigation)
Immediate and Copious Eye Irrigation for at least 2 liters irrigant over 30 minutes
1. See Eye Irrigation
2. Do not delay irrigation for exam, contact removal, or sterile fluid
Measure pH of ocular surface 5 minutes after initial irrigation
1. Further irrigation until pH neutralized to 7.0 to 7.5
2. Recheck pH to confirm stability at 30 minutes
Sweep upper and lower lids with a moist cotton swab
1. Removes any retained crystallized chemical particles

Precautions
1. Do not patch eye (increased risk of infection)
Topical agents: All chemical eye burns with any Corneal Epithelial Disruption, Fluorescein uptake
1. Antibiotic eye drops (e.g. Erythromycin, Ciprofloxacin, Gentamycin, Tobramycin)
2. Preservative-free artificial tears
Topical agents: Grade 3-4 Chemical Burns
1. Add in combination with Topical Antibiotics and artificial tears described above
2. Topical Corticosteroids (e.g. Prednisolone) or in combination with Antibiotic (e.g. Tobradex)
3. Consider Cycloplegic agent (e.g. Cyclopentolate or Cyclogyl, Scopolamine 0.25%)
Disposition
1. Recheck within 24 hours
2. Recheck Intraocular Pressure, Corneal surface, lid injury
Indications for emergent or urgent ophthalmology referral
1. Strong alkali or acid burn
2. Abnormal Visual Acuity
3. Severe Eye Pain
4. Marked Conjunctival swelling or Chemosis
5. Corneal epithelial defect (Fluorescein uptake)
6. Cloudy Cornea (Corneal Opacification, Roper-Hall Grades 2-4)

Best prognosis with early copious irrigation and Grade 1-2 injuries
Corneal Opacity or ischemia is associated with worse prognosis and longterm Decreased Visual Acuity