Chemical Burns

Most acids produce the extent of their damage immediately on contact—the more concentrated the acid, the more severe the immediate effect. Alkali burns are more devastating to the eye because they continue to cause damage long after the initial chemical contact. Corneal melting can lead to perforation, and severe chronic glaucoma can occur as a later complication. Burns of the eye by acids or alkalis are true ocular emergencies. An alkaline substance, such as lye, can cause permanent and irreversible blindness.

The immediate treatment of chemical burns must be continual irrigation of the eyes, with up to 1000 mL of normal saline (NS) or lactated Ringer's (LR) solution. If these solutions are not available, water from a shower, spigot, bathtub, or drinking fountain is appropriate. The conjunctival pH should be assessed after irrigation and again 30 minutes later to confirm stabilization of the ocular surface; pH value should be 7.5 to 8. If the pH remains abnormal, irrigation should be repeated until the pH is normal. Patients are managed with aggressive antibiotic ointment therapy and lubrication following a chemical burn. After the initial ocular irrigation, ophthalmologic consultation must be immediate.

KEY TREATMENT

Chemical burns of the ocular surface should be washed with at least 1 liter of fluid and tested until the pH returns to normal. An ophthalmologist should evaluate the affected eye within 24 hours after treatment (AAO, 2007) (SOR: C).

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