T26.9
DESCRIPTION
Damage to one or both eyes caused by contact with irritating chemical substances, either alkali or acid.
Presentation:
- pain
- inability to open eye
- blurred vision
- excessive tearing
DIAGNOSTIC CRITERIA
- To assess extent of epithelial loss, after irrigating the eye/s, stain the cornea with fluorescein 2%.
Note:
If the entire cornea stains, then all the epithelium has been removed by the chemical substance. Compare fluorescein staining in the other eye.
GENERAL AND SUPPORTIVE MEASURES
Try to ascertain the exact nature of the chemical agent (without causing a delay in management and referral) by the checking of the pH of the conjunctival sac with litmus paper. (Alternatively the pH square of a urine test strip may be used) Normal tear pH: 6.5–7.6.
Irrigate affected eye/s immediately and continuously with copious amounts of sterile water (at least 2L). Use an eye speculum and an IV fluid delivery set.
If chemical agent is alkaline, prolong irrigation.
Note: Do not attempt to neutralise alkali with acid or vice versa.
MEDICINE TREATMENT
Anaesthetise eye/s after rinsing the eye and before instilling fluorescein
- Topical anaesthetic, e.g. Amethocaine ophthalmic drops, instil 1 drop. Repeat every 15 minutes, if necessary.
For pain:
- Paracetamol, oral, 15 mg/kg/dose, 6 hourly as required.
REFERRAL
Urgent
- Any severe chemical burn producing any epithelial loss or cloudiness of the cornea and/or conjunctival blanching.