Chemical Burn to the Eye
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T26.9 DESCRIPTION Damage to one or both eyes caused by contact with irritating chemical substances, either alkali or acid. Presentation: pain, inability to open the eye(s), blurred vision, and excessive tearing. DIAGNOSTIC CRITERIA To assess the extent of epithelial loss, after irrigatin
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: T26.9
DESCRIPTION
Damage to one or both eyes caused by contact with irritating chemical substances, either alkali or acid.
Presentation:
- pain,
- inability to open the eye(s),
- blurred vision, and
- excessive tearing.
DIAGNOSTIC CRITERIA
- To assess the extent of epithelial loss, after irrigating the eye(s), stain the cornea with fluorescein 2%.
Note:
If the entire cornea stains, then all the epithelium has been removed by the chemical substance. Compare to fluorescein staining in the other eye.
GENERAL AND SUPPORTIVE MEASURES
Try to ascertain the exact nature of the chemical agent (without causing a delay in management and referral) by checking the pH of the conjunctival sac with litmus paper. (Alternatively, the pH-square of a urine test-strip may be used.) Normal tear pH: 6.5 - 7.6.
Irrigate affected eye(s) immediately and continuously with copious amounts of sterile water (at least 2 L). Use an eye speculum and an IV fluid delivery set. If the chemical agent is alkaline, prolong irrigation.
Note:
Do not attempt to neutralise alkali with acid or vice versa.
MEDICINE TREATMENT
Anaesthetise eye(s) after rinsing the eye(s) and before instilling fluorescein.
- Topical anaesthetic, e.g. oxybuprocaine, ophthalmic drops, instil 1 drop. Repeat every 15 minutes, if necessary.
For pain:
- Paracetamol, oral, 15 mg/kg/dose 6 hourly as required.
REFERRAL
Urgent
- Any severe chemical burn producing any epithelial loss or cloudiness of the cornea and/or conjunctival blanching.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 16: Eye Conditions, 16.5 Chemical Burn To The Eye