Ocular Exposures

Ocular injuries after caustic exposures can be devastating to vision. The Eye Bank Association of America reports that 300 of the 1000 corneal transplants in the

United States in 1995 were secondary to eye injuries caused by chemicals.14 Caustic alkali injuries to the eye are generally more severe than acid-related eye injuries. Alkali injuries penetrate deep into ocular tissue and continue to be destructive after superficial removal, whereas acidic injuries are usually superficial. The coagulation necrosis after acid injury limits the penetration of acid into ocular tissue.

Ocular injuries should be immediately treated with copious irrigation ( Fig 175-2). Patients should have continuous irrigation with at least 2 L of normal saline per affected eye. Nitrazine (pH) paper should be utilized to ensure that the offending acid or base is eliminated. The expected pH after irrigation should be between 7.5 and 8.0, and irrigation should continue until this pH range is achieved. A waiting period of 10 min before checking the pH will more accurately reflect the pH of the eye and not the irrigation fluid. After irrigation, all patients should have a complete eye exam, including fluorescein staining, and all except the most superficial exposures should have ED ophthalmology consultation.

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FIG. 175-2. Guidelines for treatment of caustic ocular exposures.

A recently reported ocular injury that ED clinicians should be aware of is alkali keratitis after deployment of motor vehicle airbags. A small amount of aerosolized sodium hydroxide and sodium carbonate is released during airbag deployment. These caustic alkalis may enter the eye and cause significant injury. The recommendation is to treat these injuries as other caustic ocular exposures, with copious irrigation, pH testing, and ophthalmology consultation. «I6

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