Eye Irrigation

1. Indications
   1. Chemical Eye Injury
   2. Eye Foreign Body
2. Contraindications
   1. Globe Rupture
3. Equipment
   1. pH paper
   2. Eye Irrigation fluid (Use best option that is immediately available)
      1. Eyewash station (allows for immediate copious, continuous irrigation)
      2. Preferred irrigants (liter bags - may require up to 10 liters)
         1. Normal Saline or
         2. Lactated Ringers
      3. Alternatives if preferred agents unavailable
         1. Sterile water
         2. Clean water supply (water tap with potable, drinkable water supply)
   3. Irrigation additives
      1. Consider placing 10-15 cc of 1% Lidocaine in a 1 L saline bag to maintain adequate topical Anesthesia during irrigation
      2. Consider warmed fluids (not hot!) for irrigation
   4. Irrigation device (any clean device that can direct irrigant flow to eye)
      1. Morgan Medi-Flow lens
      2. Intravenous tubing
      3. Nasal canula (attached to IV tubing)
         1. Can straddle the Nasal Bridge such that each nasal prong can be directed toward each eye
4. Technique: Chemical Eye Injury
   1. Pre-treat with Topical Eye Anesthetic (if available)
   2. Do not delay irrigation for contact removal if unable to promptly remove after Chemical Eye Injury
      1. Contacts can be removed after irrigation
   3. Immediate copious irrigation (for at least 30 minutes for significant Chemical Eye Injury)
      1. After irrigation, close eye for 5 minutes
      2. Test Eye pH (goal is neutral pH 7.0 to 7.3)
         1. Continue Eye Irrigation until Eye pH 7.0 to 7.3 (may require up to 10 liters of irrigant)
         2. If pH paper not available, irrigate for minimum of 2 liters irrigant over 30 minutes
   4. Adjunctive measures
      1. Retract the upper and lower Eyelids during irrigation to ensure irrigation of the fornices
      2. Consider sweeping medial and lateral canthus for crystallized chemical
         1. Use moist swab to remove debris from Conjunctival fornices
         2. May be speed neutralization of pH
5. Precautions
   1. Never use acid or base to neutralize Chemical Burn
6. Efficacy
   1. Eye Irrigation reduces risk of serious Eye Injury and dramatically reduces healing times
      1. Ikeda (2006) Ophthalmologica 220:225-8 [PubMed]
7. References
   1. Warrington (2022) Crit Dec Emerg Med 36(9): 16