Chemical Injury

I’ve spent a great deal of time exploring the relationship between head trauma and vision. In this blog I plan to briefly examine chemical injuries to the eye. Approximately 10% -20% of all direct ocular trauma is chemical. This most frequently happens at the workplace but our environment is filled with toxic chemicals- injury can occur anywhere.

Individuals are intimately aware of the threat of a chemical splash- we have an immediate reflex to close our eyes in the event of a spill. The danger is real- acid and alkali injuries to the surface of the eye can have devastating consequences. Alkali injuries such as exposure to bleach are the most serious.

The surface of the eye is covered by sensitive conjunctival and corneal epithelial cells. The cornea is the front clear surface of the eye and the conjunctiva is the white part. Both of these structures are vital to eye health and vision, and have numerous pain receptors.

In the event of a toxic exposure to the eye, the single most important treatment and vision saving intervention is immediate irrigation with water. As an ophthalmologist I cannot emphasize this enough. You don’t need an eye doctor- you just need water and lots of it. The immediate dilution of acids or alkali chemicals provides the greatest chance for long-term maintenance of vision. Public places have flowing water, high risk areas have special eye irrigation fountains.

One can never irrigate too much, even when a person thinks it’s enough, it’s really not. It may be painful and difficult to the person injured (we all dislike having water poured in our eyes) but it is difficult to neutralize strong chemicals, powders are the worst.

The next stop is usually the emergency room. The ER doctor can then decide if the ophthalmologist needs to be called. Chemical spills to the eye can be true emergencies. Trained ophthalmologists are experienced and skilled in treating such patients. I have seen hundreds, if not thousands, of such injuries in my 30 years in practice.

Treatment is based on the severity of the chemical burn. The ocular surface has stem cells which replace the normal shedding of epithelial cells. If enough of these stem cells are damaged, the outcome is more likely to be poor. Treatment ranges from eye drops to surgery. Long-term, many of these patients may experience dry eyes and ocular surface disease even if they heal. I have been the principal investigator in numerous large clinical trials of dry eyes and ocular surface disease.

The message of this blog is simple: irrigate the eyes with water, then seek medical attention. And don’t be shy about the amount of water.

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