Chemical in the Eye

CHEMICALS IN THE EYE

Symptom Definition: Chemical gets into the eye from fingers, contaminated object, spray or splash.

Background Information:

Harmless Substance:

The following liquid products are harmless to the eye: bubble bath, cosmetics, deodorant, foods (e.g. lemon juice), hair conditioner, hair spray, hand lotion, laundry detergent (liquid), medications, shampoo, shaving cream, soap, sunscreen, and toothpaste.
The following substances are also generally harmless, but will cause transient irritation: hydrogen peroxide, rubbing alcohol and vinegar.
Mace: Mace and pepper spray are used in personal protection devices. Eye exposure results in marked eye pain and tearing. Usually these symptoms subside in 30 minutes and there is no lasting damage.

Harmful Substances:

Eye contact with acids or alkalis can cause severe damage to the eye. All need immediate irrigation followed by immediate referral to an emergency department.
Acids: Acids include hydrochloric acid, nitric acid, sulfuric acid, phosphoric acid, oxalic acid, or any other product labeled as an acid. It should be assumed that products called toilet bowl cleaners, metal cleaners, descalers, or battery fluid contain acid until proven otherwise.

+ FIRST AID Advice for Chemical in the Eye.

Immediate and thorough irrigation of the eye with tap water should be performed (Reason: to prevent damage to the cornea). If one eye is not burned, cover it (if possible) while irrigating the other.
Duration:
- For harmless substances (e.g. sunscreen or hair spray), irrigation only needs to be carried out for 2-3 minutes.
- For stronger chemicals that cause more irritation and stinging (e.g. ammonia, vinegar, alcohol or household bleach), flush the eye for 5-10 minutes.
- For acids, irrigate the eye continuously for 10 minutes.
- For alkalis, irrigate the eye continuously for 20 minutes.
For any chemical particles that cannot be flushed away, wipe them away with a moistened cotton swab.
Never irrigate with antidotes such as vinegar. (Reason: the chemical reaction can cause more damage.

Triage Assessment Questions for Chemical in the Eye

A. Go to ED NOW (or Office with PCP Approval)

Shortness of breath

Reason: possible bronchospasm or pulmonary involvement

Acid or alkali was the chemical (as defined in Background Information)

(Exception: mild agents such as household bleach or ammonia - instead Call Poison Center)

+ First Aid: Irrigate eye immediately before going to the ED.

Sounds like a serious injury to the triage nurse

B. Go to Office NOW

Cloudy spot or sore on the cornea (clear central part of eye)	+ First Aid: Irrigate eye immediately afterwards
Blurred vision that persists >1 hour after irrigation	R/O: corneal damage
Eye pain that persists > 1 hour after irrigation	R/O: corneal damage
Continued tearing or blinking that persists > 1 hour after irrigation.	R/O: corneal damage

C. Call Poison Center NOW

Possibly harmful substance in the eye (Exception: MACE, pepper spray, soap. sunscreen lotion or other obviously harmless substance)	+ First Aid: Irrigate eye immediately before calling Poison Center
Blurred vision that persists >1 hour after irrigation	R/O: corneal damage
Eye pain that persists > 1 hour after irrigation	R/O: corneal damage
Continued tearing or blinking that persists > 1 hour after irrigation.	R/O: corneal damage

D. See Today in Office

Redness persists >24 hours	+ First Aid: Irrigate eye immediately afterwards
Patient wants to be seen	R/O: conjunctivitis

E. Home Care

MACE or "pepper Spray" was sprayed into face/eyes	+ First Aid: Irrigate eye immediately afterwards
Eye irritation from harmless chemical

Home Care Advice for Harmless Chemical in the Eye

1. Irrigate the eye immediately.

2. Eye Irrigation Method #1 -- Flushing:

Slowly pour lukewarm water into the eye from a pitcher or glass.
Or, place your head under a gently running faucet or shower.
Hold the eyelid open during this process.

3. Eye Irrigation Method #2 -- Immersion:

Immerse the entire face into a sink or basin filled with lukewarm tap water.
With the face under water, open and close the eyelids. You may need to use your fingers. Look from side to side.

4. Duration of Irrigation for Harmless Substances:

For harmless substances (e.g. household soap, sunscreen or hair spray), irrigation only needs to be carried out for 2-3 minutes.
For stronger chemicals that cause more irritation and stinging (e.g. ammonia, vinegar, alcohol or household bleach), flush the eye for 5-10 minutes.

5. Vasoconstrictor Eye Drops: Red eyes from irritants usually feel much better after the irritant has been washed out. If they remain uncomfortable and bloodshot, use some long-acting vasoconstrictor eye drops (e.g. Visine). Use 1 to 2 drops. May repeat once in 8-12 hours.

6. Contacts: Patients with contact lenses need to switch to glasses temporarily. (Reason: to prevent damage to the cornea)

7. Expected Course: The pain and discomfort usually pass 1 hour after irrigation.

8. Call Back if:

Pain or blurred vision lasts longer than 1 hour after irrigation
Redness lasts longer than 24 hours
You become worse.

This protocol was generously contributed by David Thompson, MD.

Dr. Thompson's book on Adult Telephone Protocols: Office Version (Spiral-bound; 2004) can be found at this Amazon.com address.
Please click here to access more information about Dr. Thompson's Telephone Triage Algorithms - Adult After-Hours Version.