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chemical injuries and burns to the eyes

see also:


  • exposure of a chemical even in powder or dust form, may cause serious long term damage to the eye, particularly if they are alkali as they penetrate deeper into the ocular surface

First aid

  • if possible check the pH of both eyes by pulling down lower lid, place pH strip (NOT urine strips as these apparently over-estimate the alkalinity) in the lower fornix (space between eyelid and globe), and release lid and wait for a few seconds until some tears are absorbed onto strip, then remove and read the pH.
  • instill a drop of local anaesthetic
  • all patients should then have immediate first aid copious eye irrigation using 1L normal saline or Hartmann's solution
    • following irrigation, wait 10 minutes and re-check pH
    • continue above until pH is 7.5 or the same as the unaffected eye
    • if pH is still high after 3L irrigation, carefully check eyes for particulate matter (evert and sweep eyelids)
    • if pH is normal, re-check 30 minutes later to confirm it has stayed normal.

Full anterior segment examination

  • once pH is normal a formal eye exam should be undertaken with a slit lamp if possible
  • instill a drop of local anaesthetic
  • evert and sweep under eyelids to remove particulate matter
  • examine cornea for haze and epithelial defects using fluorescein stain
  • NB. a total epithelial defect can be missed if there is no bordering normal epithelium demarcating the staining
  • if there is staining over the limbus, this may indicate ischaemia of the limbus
    • check capillary refill at limbal edge using a cotton bud to compress limbal vessels then observe for reperfusion

determine severity using the Roper-Hall classification

grade clinical features
Grade I corneal epithelial defect; no corneal haze; no ischaemia
Grade II mild corneal haze; iris details visible; ischaemia < 1/3rd limbus
Grade III total corneal loss; stromal haze obscures iris detail; ischaemia 1/3rd - 1/2 limbus
Grade IV cornea opaque; iris and pupil obscured; ischaemia > 1/2 limbus (eg. “white eye”)

further Mx according to grade

  • all cases with corneal epithelial defect or reduced vision should be reviewed by an ophthalmology registrar

grade I/II

  • chloramphenicol eye drops qid
  • consider flourometholone eye drops qid
  • if grade II or a toxic exposure (eg. alkali/acid), review every 1-2 days until closure of defect to monitor for complications
  • advise to return if increasing pain, photophobia or decreased vision

grade III/IV

  • consider admission under ophthalmology for possible debridement of necrotic tissue
  • chloramphenicol eye drops qid
  • flourometholone eye drops hourly
  • ascorbic acid 10% eye drops 2hrly
  • sodium citrate 10% eye drops 2hrly
  • homatropine 2% eye drops tds or atropine 1% eye drops tds
  • preservative free ocular lubricants prn
  • ascorbic acid 500mg orally qid
  • ural sachet tds
  • oral analgesia prn


  • RV Eye and Ear Hospital, Melbourne 2018
  • Brodovsky SC et al. Mx of alkali burns. Ophthalmology. 107:1829-1835 2000
eye_chemical.txt · Last modified: 2018/07/25 17:54 (external edit)