Welcome to question of the day #197

Eyetools question of the day #197

Over my career, I’ve had two people run into my practice having had chemicals splash into their eyes. Of course, the level of potential injury depends on the nature of the chemical entering the eye. Some chemicals react so harshly with the eye that they can have catastrophic effects on the ocular surface and vision.

The first minutes after the chemical has entered the eye are crucial. What happens in these first few minutes determines the amount of damage and the level of vision at the end of treatment. It is essential that eye care specialists have a good sense of what first aid to offer in those first minutes.

Perhaps not surprisingly, the incidence of chemical eye injury is highest in men (ratio 3-8:1) of working age (typically 20-30 years), with two-thirds occurring at work. This is associated with poor use of protective eyewear and poor knowledge of first aid management

Sadly, assault accounts for one-third of severe injuries and causes more permanent damage due to the toxic nature of the chemicals used (e.g. ammonia) and reduced access to emergency treatment.

Alkalis account for two-thirds of injuries, with the resultant damage related to the rate of penetration of the ocular surface. Alkali chemicals are much more penetrative than acids.

If a patient phones or comes into the practice, ask them what first aid treatment they have applied. The eyes must be flooded with clean water or saline from a tap, hose pipe, or water bottle. By flooded I mean that the face, hair, and clothes become soaked and the floor drenched as so much water has been poured into the eyes. The application of water should continue for around five minutes. It might be that the chemical reaction causes the eyes to close. They must be prized apart in order to get the water in. Another person, if available, could help. It may be helpful to lie the patient when applying the water or saline. Contaminated clothing should be removed.

Once the first aid treatment has been completed,  the patient must go immediately to an accident and emergency department, where attempts can be made to identify the chemical and treatment initiated. Consider phoning ahead to alert the hospital staff that the patient is on their way, what has happened and the details of the first aid treatment you initiated. Note the patient details you have and your actions in the clinical records.