A 24 years-old male presented to the emergency department with red-eye after direct contact with a chemical agent. You are the senior medical student/intern who should see the patient first.
How would you approach to this patient?
To learn more about it, read chapters below.
Read "Eye Trauma" Chapter
Read "Red Eye" Chapter
Quick Read
Chemical Injuries
Eye traumas caused by chemical substances constitute a wide spectrum ranging from corneal abrasions, which are simple burn symptoms, to serious burns that can result in permanent blindness. The most commonly encountered chemicals are cleaning materials, personal care items, and automobile chemicals. Alkaline chemical injuries are more common than acidic ones. Because acidic materials lead to coagulation necrosis and scar formation, deep penetration is restricted. Alkaline materials cause deeper wounds due to liquefaction necrosis. Burns are grouped into four grades, based upon intensity.
Chemical Burn Grades
- Grade 1: Only epithelial damage; no limbal ischemia.
- Grade 2: Obscurity on the cornea; however, iris details can be spotted and there is ischemia in less than 1/3 of the limbus.
- Grade 3: Total loss of corneal epithelia. Stromal obscurity prevents spotting iris details. 1/3–1/2 limbal ischemia.
- Grade 4: The cornea is completely opaque and there is >50% limbal ischemia.
What to do!
While the prognosis is good for grades 1 and 2, it is poor for grades 3 and 4. The first thing to do when a chemical substance contacts the eye is to irrigate it with normal saline or Ringer’s lactate solution in order to neutralize the eye’s pH. Applying a local anesthetic will relieve the patient’s pain. If care is being administered at the scene, tap water can be used for irrigation. Grade 1 and 2 injuries can be treated with antibiotics, steroids, and cycloplegic drugs. As antibiotics, preparations containing tobramycin or quinolone (ciprofloxacin, ofloxacin) can be used 4–5 times per day. Steroids decrease inflammation and prevent neutrophil activation. Grade 3 and 4 injuries may require surgical treatment.
