GuidelinesPrimary Care STG
Eye Injury, Chemical Burn
Eye Injuries
T26.9 + (X49.99)
|
This is a medical emergency |
DESCRIPTION
Damage to one or both eyes caused by contact with irritating chemical substances e.g. alkali or acid.
Presents with:
- Pain
- Blurred vision
- Inability to open eye
- Excessive teary and watery eye
GENERAL MEASURES
- Irrigate or wash the eye immediately and continuously with sterile water or sodium chloride 0.9% for at least 30 minutes (1-3 L of fluid) and until the pH of the ocular surface has returned to approximately 7.4. A urine dipstick can be used to measure this when gently placed at the lateral canthus of the eye. Recheck the pH 5 minutes after completing irrigation to ensure it remains normal. Continue irrigation if the pH becomes abnormal again. If repeatedly abnormal after cessation of irrigation, check for retained debris and remove gently with a cotton bud.
- In severe alkaline burn cases, irrigation should be prolonged further.
- Ensure that the eye is irrigated so that the fluid runs away from the unaffected side (i.e., nasal to lateral).
LoE:III5
MEDICINE TREATMENT
Local anaesthetic if needed:
- Tetracaine 1% eye drops, instil 1 drop in the affected eye(s). Can be repeated if needed.
- Repeat irrigation of the eye.
- Evert upper eyelid and remove debris with cotton bud.
- Never give anaesthetic drops to the patient to take home as they can cause blindness if used too often.
- Chloramphenicol 1%, ophthalmic ointment, applied 6 hourly.
Pain:
Children
- Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See: dosing table.
Adults
- Paracetamol, oral, 500 mg - 1 g, 4–6 hourly when required (to a maximum of 4 g in 24 hours).
- Maximum dose: 15 mg/kg/dose.
REFERRAL
- All cases within 12 hours.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_30 September 2024
Chapter 18: Eye Conditions_18.3 Eye Injuries_18.3.1 Eye Injury, Chemical Burn