Chemical injury to the eye ►

DEFINITION Accidental or intentional exposure of the eye to chemical

agents with potentially blinding complications.

AETIOLOGY Assault, accidental.

ASSOCIATIONS/RISK FACTORS Industrial chemical exposure.

EPIDEMIOLOGY Common source of eye injuries presenting to A&E.

HISTORY Most patients will remember a chemical insult. They will

complain of pain, photophobia, reduced vision, and difficulty in eye
opening. It is essential to ascertain the chemical agent if possible.

EXAMINATION
• Should be preceded by urgent irrigation as below and measurement
of pH if available. This is assuming that there are not more pressing
life-threatening injuries needing attention .
• The eye will typically be red; however severe injury can lead to the
appearance of a white conjunctiva as all of the vessels are blanched.
The cornea will be opacified in severe injuries. Whiteness of the
limbus can suggest limbal ischaemia.
• Slit lamp examination may show anterior chamber inflammation.
• The chemical agent may cause facial burns or burns elsewhere which
must be appropriately assessed and treated. Ophthalmologists will
monitor intraocular pressures if they are concerned about
inflammation in the anterior chamber.

PATHOLOGY /PATHOGENESIS
• Alkali injuries are frequently more severe than those caused by acids.
Due to saponification of fatty acids in cell membranes, alkali can
penetrate deep into the eye and lead to substantial intraocular
inflammation and damage.
• Damage from strong acids can be no less severe; however, in most
cases, acids will lead to the denaturing of proteins on the surface of
the eye, thus creating a barrier to further penetration of the
chemical agent.
• The limbal stem cells are responsible for maintaining the corneal
epithelium hence the concern from limbal ischaemia.
INVESTIGATIONS pH measurement.
MANAGEMENT
• Immediate irrigation of the eye with normal saline.
• Eye opening may be maintained with an eyelid speculum and a drop
of topical anaesthetic after pH measurement. Irrigation should
continue until the pH is 7.0-7.5. Swabs should be used to sweep
away any particulate matter including that which may have
accumulated under the eyelids.
• Mild injury with a clear cornea and no limbal ischaemia may not
need ophthalmology follow-up.
• More severe injury may require treatment to control raised
intraocular pressures, inflammation or promote healing of the
corneal epithelium. Severe injury may need treatment with amniotic
membrane grafting, limbal stem cell transplant or corneal transplant.
COMPLICATIONS Glaucoma, cataract, permanent corneal opacification .

PROGNOSIS Corneal opacification (iris details obscured) and limbal

ischaemia are adverse prognostic factors.