Chemical burn

Exposure of the eye to any chemical can cause significant damage to the anterior segment.
Industrial agents containing alkali or acid are especially devastating to the eye. Alkalis are 
more dangerous than acids.
Chemical burn is one condition where immediate treatment should precede examination as 
the amount of damage is related to the duration of the exposure.

Management:

  • Wash the eye with copious amounts of water with the eye open.
  • If the patient had severe blepharospasm instill topical anaesthesia and continue 

  • irrigation
  • If the burn is caused by household detergent and there was minimal discomfort then 

  • referral is not necessary
  • If the burn is caused by industrial agents or any unknown agents, refer the patient to

  • the eye casualty immediately
  • In the casualty, the pH of the eye is measured (normal pH is around8). If the pH is too 

  • high or low further irrigation is peformed.
  • The severity is assessed by the degree of corneal opacities and limbal ischaemia 

  • (whiteness around the cornea)
     
Figure 1.
An eye with severe chemical burn showing opacification of the cornea and whiteness 
around the corneal (limbal ischaemia). Immediate washout is the most important first 
step. Further treatment involves reducing the inflammatory process with topical steroid 
and the use of topical and systemic vitamin C to enchance healing.

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