Chemical Eye Injury
Known or suspected chemical exposure to eye. DO NOT DELAY - begin irrigation immediately
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OphthalmologyEmergency
Chemical Eye Injury Management
Chemical Eye Injury Management: Chemical Eye Injury → IMMEDIATE Copious Irrigation → Check Conjunctival pH → pH Normalized (7.0-7.2)? → Grade Injury (Ro...
Pathway Overview
14 steps
Algorithm Steps
14 total
01Start 02Action IMMEDIATE Copious Irrigation
START BEFORE ANY OTHER ASSESSMENT. Time to irrigation is the most important prognostic factor
- Use any available fluid: water, saline, LR
- Irrigate nasal to lateral (away from unaffected eye)
- Evert lids to irrigate fornices
- Remove particulate matter with cotton swab
- Continue for minimum 30 minutes
03Action Check Conjunctival pH
Wait 5 minutes after stopping irrigation before checking pH
- Target pH: 7.0-7.2
- If pH abnormal, continue irrigation
- May need 2-20L for severe alkali burns
- Recheck pH every 15-30 minutes initially
04Decision pH Normalized (7.0-7.2)?
Continue irrigation until pH stable in physiologic range
05Action Grade Injury (Roper-Hall)
Assess corneal clarity and limbal ischemia
- Grade I: Epithelial damage only, no limbal ischemia - Good prognosis
- Grade II: Corneal haze but iris visible, <1/3 limbal ischemia - Good prognosis
- Grade III: Total epithelial loss, stromal haze obscures iris, 1/3-1/2 limbal ischemia - Guarded
- Grade IV: Opaque cornea, >1/2 limbal ischemia - Poor prognosis
06Decision Injury Grade?
Treatment intensity based on severity
07Action Grade I-II Treatment
Outpatient management possible
- Topical antibiotic (erythromycin or fluoroquinolone QID)
- Prednisolone acetate 1% QID
- Cycloplegic (cyclopentolate TID) for comfort
- Preservative-free artificial tears PRN
- Follow-up in 24-48 hours
08Action Close Follow-up
Monitor for complications
- Daily initially for severe injuries
- Watch for: persistent epithelial defect, corneal melting, glaucoma
- IOP elevation common - may need treatment
- Symblepharon prevention with sweeping/lysis
09Outcome Healing/Recovery
Grade I-II typically heal with good visual outcome
10Outcome Cornea/Ocular Surface Specialist
Grade III-IV require long-term specialist care for stem cell failure, chronic disease
11Action Grade III-IV Treatment
Aggressive treatment required - consider admission
- Fluoroquinolone drops QID
- Prednisolone acetate 1% HOURLY while awake (first 7-10 days)
- Oral vitamin C 2g QID (promotes collagen synthesis)
- Topical sodium ascorbate 10% HOURLY
- Doxycycline 100mg BID (inhibits collagenase)
- Atropine 1% for cycloplegia
- Debride necrotic epithelium
12Warning ⚠️ Steroid Management After Day 10-14
Risk of corneal perforation increases if steroids continued beyond 10-14 days. Taper or switch to medroxyprogesterone
- Path rejoins step 08Shared downstream outcome
13Action Surgical Interventions
For severe Grade III-IV injuries
- Amniotic membrane transplant (within first week ideal)
- Tenonplasty for limbal necrosis
- Limbal stem cell transplant for severe ischemia
- Keratoprosthesis for end-stage
- Glaucoma surgery if IOP elevated
- Path rejoins step 08Shared downstream outcome
14Action Continue Irrigation
pH not normalized - continue until neutral
- Path rejoins step 03Shared downstream outcome
Guideline Source
AAO EyeWiki Chemical Injury Guidelines + Roper-Hall Classification
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Alkali burns are generally more severe than acid burns
- Long-term outcomes depend on limbal stem cell survival
- Severe burns may require limbal stem cell transplant or keratoprosthesis
- Does not address thermal or radiation burns
Applicable Regions
USEUGlobal
EU: Diphoterine may be available as alternative irrigating solution
US: Standard irrigation with saline or LR
Version 1Next review: 2028-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Chemical Eye Injury Management?
The Chemical Eye Injury Management is a emergency clinical algorithm for Ophthalmology. It provides a structured decision tree to guide clinical decision-making, based on AAO EyeWiki Chemical Injury Guidelines + Roper-Hall Classification.
What guideline is the Chemical Eye Injury Management based on?
This algorithm is based on AAO EyeWiki Chemical Injury Guidelines + Roper-Hall Classification (DOI: 10.2147/OPTH.S183206).
What are the limitations of the Chemical Eye Injury Management?
Known limitations include: Alkali burns are generally more severe than acid burns; Long-term outcomes depend on limbal stem cell survival; Severe burns may require limbal stem cell transplant or keratoprosthesis; Does not address thermal or radiation burns. Individual patient factors may require deviation from these recommendations.
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