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Chemical injury

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Checked: 23-01-2020 by Vicky Ryan Next Review: 23-01-2021

Overview

This is an emergency, often most workplaces using hazardous materials will have eye wash facilities

Who to refer

Only refer following irrigation.

All cases should be referred to a facility which can check pH and examine the eye with topical fluorescein.

Red Flags

Signs that the patient will require review following irrigation are:

Pain
Reduced vision
Any Fluorescein uptake
Hazy cornea

Before referral

The most important first aid is adequate irrigation. Put topical anaesthetic drops into the eye and use copious amounts of Normal Saline (or tap water if not available). Lie the patient flat and (if possible) using an intravenous giving-set run saline while pulling the eye lids from the globe to adequately wash the conjunctival sacs. A cotton bud can be put into the conjunctival sacs between the eye lid and the globe to remove any retained solid debris.

Irrigate until the pH returns to normal. Then wait 20 minutes and recheck the pH - if it remains normal the chemical has been successfully washed out. If the pH changes after 20 minutes, repeat irrigation until pH is normal. If struggling to reduce pH please discuss with the on-call ophthalmologist.

Referral

All cases should be referred to a facility which can check pH and examine the eye with topical fluorescein.

Resources

These guidelines have been written by Rhys Harrison, consultant ophthalmologist at Bristol Eye Hospital, with thanks to the patients who have kindly given consent to use their photos.

For full ophthalmology guidelines see: Primary Care Ophthalmology Guidance Document

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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