Trauma

Chemical Eye Injury

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Chemical Eye Injury, Eye Chemical Burn, Ocular Chemical Burn

  • Causes
  1. Strong acids and bases
  • Epidemiology
  1. Common Work-Related Eye Injury
  2. Also occurs with home cleaning products (e.g. bleach)
  • Risk Factors
  • Most eye damaging agents
  1. Strong bases/alkali such as bleach (pH > 10, associated with worse outcomes)
  2. Hydrofluoric acid (semiconductor production)
  • Pathophysiology
  1. Damage to Conjunctiva and Corneal
  2. Ischemia may result from adjacent injury to Conjunctival or Scleral vessels
  • Symptoms
  1. Severe Eye Pain
  2. Photophobia
  3. Blurred vision
  4. Eye Foreign Body sensation
  • Signs
  1. Reflex blepharospasm
  2. Conjunctival or Corneal color
    1. Red Eye (most common)
    2. White eye (Corneal clouding) suggests severe Eye Injury with ischemia
  • Exam
  1. Litmus paper (acid-base pH paper) applied to Conjunctival fornix (where bulbar and palpebral Conjunctiva meet)
  2. Visual Acuity
  3. Observe eye appearance for injury
    1. Corneal Opacification or clouding
    2. Conjunctival injection
  4. Observe for Eyelid Swelling or Burn Injury
  5. Fluorescein stain for Corneal epithelial defect
  • Grading
  • Roper-Hall Classification
  1. Grade 1: Mild Corneal epithelial damage
  2. Grade 2: Corneal Stromal haze but maintained visible iris details
  3. Grade 3: Corneal Stromal haze obscures iris details
  4. Grade 4: Cornea completely Opaque, completely blocking any view of iris
  5. Roper-Hall (1965) Trans Ophthalmol Soc 85:631-53 [PubMed]
  1. See Eye Irrigation
  2. Ocular Emergency requiring immediate management
  3. Apply topical anesthetic to eye or add Lidocaine to saline irrigation bag (see Eye Irrigation)
  4. Immediate and Copious Eye Irrigation for at least 2 liters irrigant over 30 minutes
    1. See Eye Irrigation
    2. Do not delay irrigation for exam, contact removal, or sterile fluid
  5. Measure pH of ocular surface 5 minutes after initial irrigation
    1. Further irrigation until pH neutralized to 7.0 to 7.5
  6. Sweep upper and lower lids with a moist cotton swab
    1. Removes any retained crystallized chemical particles
  • Management
  • Following Irrigation to neutral pH
  1. Precautions
    1. Do not patch eye (increased risk of infection)
  2. Topical agents: All chemical eye burns with any Corneal Epithelial Disruption, Fluorescein uptake
    1. Antibiotic eye drops (e.g. Erythromycin, Ciprofloxacin, Gentamycin, Tobramycin)
    2. Preservative-free artificial tears
  3. Topical agents: Grade 3-4 chemical burns
    1. Add in combination with Topical Antibiotics and artificial tears described above
    2. Topical Corticosteroids (e.g. Prednisolone) or in combination with antibiotic (e.g. Tobradex)
    3. Consider Cycloplegic agent (e.g. Cyclopentolate or Cyclogyl, Scopolamine 0.25%)
  4. Disposition
    1. Recheck within 24 hours
  5. Indications for emergent or urgent ophthalmology referral
    1. Strong alkali or acid burn
    2. Abnormal Visual Acuity
    3. Severe Eye Pain
    4. Marked Conjunctival swelling or Chemosis
    5. Corneal epithelial defect (Fluorescein uptake)
    6. Cloudy Cornea (Corneal Opacification, Roper-Hall Grades 2-4)
  • Prognosis
  1. Best prognosis with early copious irrigation and Grade 1-2 injuries
  • Resources
  1. Toxic Substances and Disease Registry
    1. http://www.atsdr.cdc.gov