Chemical injury (Guidelines)

Immediate treatment (and neutralisation of pH)

• Test pH;
• Instill topical anaesthetic (Proxymethacaine,Bupivacaine or Tetracaine),
• Insert a speculum
• Irrigate with at least 2L of Normal saline or water through IV giving set (including into the fornices) until normal pH is restored

Inspection

• Evert the lids (if possible), inspect lids and fornices and remove any particulate material with a cotton bud (e.g. lime, cement)

pH testing

• Test pH at the end of irrigation and 5 min after.
  
  • If pH neutral/near neutral (compare to other eye if necessary), then begin examination and history taking and initiate further treatment (see below). Recheck pH after 20 mins
• If pH abnormal, repeat irrigation cycle with another 2L until pH normal

Examination

• Record visual acuity and pupil reactions
• Look for abnormal whitening of conjunctival vessels adjacent to cornea (limbal ischaemia)
• Check for corneal/conjunctival abrasions with fluorescein

Further treatment

• Topical antibiotics: Chloramphenicol eye drops 4 times per day
• Topical cycloplegia:Cyclopentolate 1% 3 times per day
• Topical steroids: Dexamethasone 0·1% 4 times per day
• Topical lubricants: Celluvisc 1% or Xailin gel 6 x a day and Xailin Night ointment at night
• Oral analgesia as required
•  Consider admitting to NTC Ophthalmology if severe injury (extensive corneal abrasion and limbal ischaemia)
• Review by Ophthalmologist same day or following morning if out of hours