Eye Irrigation

1. Indications
   1. Chemical Eye Injury
2. Equipment
   1. pH paper
   2. Eye Irrigation fluid (Use best option that is immediately available)
      1. Preferred irrigants (liter bags - may require up to 10 liters)
         1. Normal Saline or
         2. Lactated Ringers
      2. Alternatives if preferred agents unavailable
         1. Sterile water
         2. Eyewash station or equivalent clean water supply
   3. Irrigation additives
      1. Consider placing 10-15 cc of 1% Lidocaine in the saline bag to maintain adequate topical anesthesia during 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
3. Technique
   1. Pre-treat with Topical Eye Anesthetic (if available)
   2. Do not delay irrigation for contact removal
      1. Contacts can be removed after irrigation
   3. Immediate copious irrigation for at least 30 minutes
      1. After 30 minutes of 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. 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
4. Precautions
   1. Never use acid or base to neutralize chemical burn
5. Efficacy
   1. Eye Irrigation reduces risk of serious Eye Injury and dramatically reduces healing times
      1. Ikeda (2006) Ophthalmologica 220:225-8 [PubMed]