Ocular Toxins

Symptoms following ocular chemical burns include blepharospasm, clouding of the cornea, and conjunctival injection. In severe exposures, corneal ulceration or globe perforation may be evident. Cessation of pain may not necessarily be an indicator of cessation of ocular damage, particularly with penetrating toxins such as alkaline corrosives or hydrofluoric acid. Three grades of corneal involvement are described. Grade I involves irritation only; grade II includes corneal erosion, congestion, or chemosis; and grade III includes corneal stromal damage or conjunctival and scleral necrosis or both. 19 In pure ocular exposures, prehospital irrigation of the eyes for 15 to 20 min at the scene prior to transport is recommended. Contact lenses should be removed. Eye hydrotherapy can continue during transport with the use of a large water-filled container in which the patient intermittently submerges the face and blinks the eyes open and closed. In the ED, irrigation should continue until the pH of the conjunctival sac returns to 7.4. Visual acuity, fluorescein staining, and slit-lamp evaluation are indicated. Consultation with an ophthalmologist is warranted in all but the most trivial of exposures, especially for chemically induced disruption of the cornea, anterior chamber reaction, hyphema, or obvious globe perforation.

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