This patient experienced a serious chemical eye injury that requires immediate intervention. The first course of action following such an injury is to flush or irrigate the eye with water for at least 15 minutes.
Immediate and early irrigation is crucial in limiting the duration of the ongoing eye injury, with the goals of removing the caustic agent and restoring the physiologic pH of the eye. In an emergent situation, where clean water is available at the site of the injury, copious irrigation with tap water is appropriate. This should be performed prior to transporting the patient to a medical facility, as this delay in irrigation could prolong the exposure of the cornea and conjunctiva to the caustic agent and lead to worsening or irreversible eye injury. In contrast, the first course of action following a cut, scratch, or foreign body injury to the eye should be to seek immediate medical attention.
Pokhrel et al. discuss the management of ocular emergencies, including penetrating injury, retinal detachment, retinal artery occlusion, acute angle-closure glaucoma, and chemical burns. They conclude that after a chemical burn, thorough eye washing for at least 30 minutes or until the eye pH returns to physiologic range is required to prevent further injury to the eye.
Singh et al. review ocular chemical injuries and their associated management. Alkali injuries are more common than acidic burns. Chemical injury damages numerous structures of the eye, including surface epithelium, cornea, anterior segment, and limbal stem cells; damage can potentially result in permanent visual impairment. Emergent management is absolutely the most important factor in determining visual outcomes.
Illustration A lists common acidic etiologies of chemical eye burns.
Illustration B summarizes common alkaline agents that cause chemical eye injuries.
Illustration C is an image from the American Academy of Ophthalmology (aao.org
) summarizing classifications of ocular burns and depicting numerous photo examples of varying degrees of chemical eye injuries.
Answer 1: This would be appropriate for scratch injury, cut or foreign body, or facial or eye burns, but the first course of action following a chemical eye injury should be to irrigate the eye with water to decrese chemical exposure time.
Answer 3: Attempting to counteract the chemical injury with a solution of a different pH is not recommended and could cause further injury.
Answer 4: Car batteries generally contains H2SO4 and so is an acidic fluid; however, as detailed in incorrect answer 3, counteracting the fluid injury with an opposite pH solution is never the best first action.
Answer 5: This is an ophthalmic emergency; this patient requires immediate care and should not, at this point, wait to see an ophthalmologist.
Pokhrel PK, Loftus SA. Ocular emergencies. Am Fam Physician. 2007 Sep 15;76(6):829-36.
PMID:17910297 (Link to Abstract)
Singh P, Tyagi M, Kumar Y, Gupta KK, Sharma PD. Ocular chemical injuries and their management. Oman J Ophthalmol. 2013 May;6(2):83-86.
PMID:24082664 (Link to Abstract)