Chemical Injury

What's going on?

Strong acids or alkalis can cause severe damage to the eye. Alkalis are much worse than acid at causing corneal burns. The patient may lose all of their corneal epithelium but, more worryingly, may also lose the progenitor cells at the limbus that supplies the epithelial cells and allow healing. The degree of limbal cell loss tends to dictate how much damage has been done. Without an epithelium, the cornea will scar and opacify. The intraocular pressure may go up and the eye may become inflamed.

Household cleaners and chemicals are unlikely to cause significant injury, unlike oven and drain cleaners. Industrial acids and alkalis are potentially very dangerous. Wet plaster or cement can enter the eye and be sequestered into the fornices, continually bathing the eye in damaging alkali.

If I examine the patient, what will I find?

The eye will be red. The cornea may be cloudy. The normal fine vessels that run up to the periphery of the cornea may be missing, due to the limbal burn.

What if I've diagnosed it?

WASH OUT THE EYE WITH WHATEVER IS AVAILABLE.

Ideally, use sterile water but in significant injuries use tap water. Get rid of any solid particulate, as this will continue to dissolve in the tears, bathing the eye in alkali and causing progressive damage. Do not refer until the eye has been bathed continually for at least fifteen minutes. Then refer immediately if there is a significant acid or alkali injury.

What will the hospital do?

Irrigate immediately and then treat as appropriate.

Problems that may arise, and how to deal with them

Following a severe chemical burn, the patient is at risk of ocular surface problems, dry eye, cataract and glaucoma. They are likely to have regular follow-up at the eye clinic.