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5. Ophthalmology
19 Sep 2017
History Findings
Examination Findings
Measure pH using universal indicator paper in the conjunctival fornix (or a cut-off urine
dipstick if not available).
Repeat pH testing after every second litre of fluid.
Important Differentials
Initial Treatment
IMMEDIATE - EYE IRRIGATION FOR CHEMICAL BURNS
1. Instill local anaesthetic drops to affected eye/eyes.
2. Commence irrigation with 1 litre of a neutral solution, eg Hartmann’s, N/Saline (0.9%) in an
IV giving set on full flow
3. Evert the eyelid and clear the eye of any debris or foreign body that may be present by
sweeping the conjunctival fornices with a moistened cotton bud.
4. Irrigate from 3-5cm above the ocular surface. Ask the patient to look left, right, up and down
whilst irrigating.
5. A Morgan Lens may only be used AFTER the first litre has been manually irrigated as above.
Give more local anaesthetic and then carefully insert the device.
6. Review the patient’s pain level every 10 minutes and instil another drop of local anaesthetic
as required.
7. a. Review after one litre of irrigation.
a. If using a Morgan Lens, remove the device prior to review.
8. Wait 5 minutes after ceasing the irrigation fluid then check pH in BOTH eyes. Acceptable pH
range 6.5-8.5. Compare with unaffected eye’s pH if unilateral injury.
9. Consult with the senior medical officer or ophthalmologist and recommence irrigation if
necessary.
10. Severe burns and alkalis will usually require continuous irrigation for at least 30 minutes with
3 litres of fluid.
Figure 1: Acute Alkali Chemical Injury (mild/moderate)
The emergency treatment of a chemical injury has far greater impact on the final ocular
outcome than any other factor. Prompt and thorough irrigation is critical to avoiding a painful,
permanently blind eye in these patients.
Examples of acids include: toilet cleaner, car battery fluid, pool cleaner.
Examples of alkalis include: bleach, lime/cement, mortar & plaster, drain cleaner, oven
cleaner, ammonia.
Alkalis saponify ocular tissues and continue to burn deeper into the eye, hence they require
more irrigation
For medicolegal reasons, it is important to document when and how the injury occurred,
whether eye protection was present, and any on-site first aid given.
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