Ocular Chemical Injury Management, Acute (071)

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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Immediate

  • Check pH
  • Topical anaesthesia
  • Copious irrigation
    • At least 20mins and 1-2 l
  • Remove particulate matter
  • Check pH 5mins after end of irrigation, continue till pH neutral
  • Recheck pH again 30mins later, re-irrigate if not neutral

History

  • Chemical: type, volume, length of exposure
  • Mechanism of injury
  • Time of injury
  • Activity leading to injury
  • Eye protection
  • Time initial irrigation
  • Emergency tx received
  • Other injuries

Examination

  • Visual acuity
  • Fornices and lid eversion for particles
  • Conjunctiva: epithelial defect, inflammation
  • Cornea: epithelial defect, clarity, integrity, sensation
  • Limbal ischemia (0-360°)
  • IOP
  • Anterior chamber reaction
  • Lens and iris damage
  • Fundus
  • Adenexal damage
  • Consider other injuries: Skin, Oral, Resp, GI

Treatment: Severity Dependent

  • Chloramphenicol (PF) qid
  • Maxidex (PF) (up to 1°)
  • Ascorbic acid 1-2g /day and/or 10% sodium ascorbate (up to 2°)
  • Oxytetracycline 250mg qid
  • Consider Cyclopentolate 1%
  • Tx raised IOP (consider Diamox to limit topical tx)
  • Treat or refer other injuries

Follow up: Severity Dependent

  • Consider if admission is required
  • Significant injuries refer to corneal team
  • Outpatient review 1/7

Last reviewed: 08 December 2021

Next review: 08 December 2024

Author(s): Anijeet, Deepa

Version: 5

Author Email(s): [email protected]

Approved By: Ophthalmology Clinical Governance Subcommittee

Document Id: 71