Obviously this is a terrible idea, perhaps the worst idea, but now I have an excuse to talk about chemical burns to the eye. Get ready, this is gonna be gross.
Acid burns (bleach) eat through the top layer of the eye, but don’t penetrate any deeper. You’ll end up with an abrasion & conjunctivitis, but probably won’t go blind. If you’re gonna put a chemical in your eye, an acid is the way to go, or...OR, hear me out, no chemical at all.
Basic compounds penetrate the ocular surface causing severe edema & proteolysis which leads to blindness. You know in Fight Club when the dude licks his hand, pours lye on it, then starts screaming in pain as his hand starts melting. Well it’s like that, but in your eye.
This is what some alkali burns look like when they present. You may think, “that’s not too bad, the eye looks pretty white and quiet.” Well, that’s because the ammonia has obliterated the blood vessels and stem cells, leaving the eye with no way to heal itself. Not good
After a chemical injury, you want the eye to be diffusely red and angry. The eye is pissed off but it still has the vasculature to heal. Large swaths of white next to the cornea like this👇carry a miserable prognosis.
So what do you do if a pt with a chemical burn shows up in your ED? You irrigate IMMEDIATELY, before you check a pH, before you call ophtho, before you use a stethoscope to listen to body noises, before you even talk to the patient, you irrigate. Seriously, every second counts.
Flood the eye with a bunch of tetracaine, put in a Morgan lens and run a liter of saline. Then take out the lens and check pH. Repeat until pH of the ocular surface is physiologic. It’s not uncommon to go through 10-15 L before you’re done.
Irrigation with a Morgan lens sucks for the patient. It’s awful. They will not have a good time. You can help by giving light sedation and plenty of tetracaine. There was also a study that showed using a balanced salt solution over NS was more comfortable but use what you have.
Once you have the irrigation running, call ophtho. We will then admit the patient to the ophthalmic ICU and take it from there.
Sorry everybody, bleach is a base. My bad. Hydrochloric acid and sulfuric acid are the most common acid injuries. Also Hydrofluoric acid actually penetrates they eye like a base, so be aware.
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