Chemical Injury to the Eye

What Is It?

Eyes can be damaged by solid, liquid, powder or aerosol chemicals. Chemical injuries that happen in the home are most likely to be caused by soaps, disinfectants, solvents, cosmetics, drain cleaners, oven cleaners, ammonia and bleach. In agricultural settings, fertilizers or pesticides can cause eye damage. In industry, many irritating chemicals and solvents can injure the eye.

A chemical eye injury is an emergency. Damage can occur within one to five minutes. Most of the time, however, chemicals that come in contact with the eye cause only surface damage and no loss of vision. Caustic (alkaline) chemicals cause the worst damage. These include ammonia, drain cleaners, automatic dish washing detergents and oven cleaners.

Symptoms

Symptoms include:

• A burning sensation in the eye after exposure to a chemical
• Excessive tearing
• Pain
• Redness on the eye and eyelid surface
• Blurred vision

Diagnosis

After your eye has been rinsed completely, your doctor will measure the pH (acidity) of the tears in your eye to make sure the chemicals have been washed out. Then your doctor will inspect your eye for damage and test your vision with an eye chart.

Normally, the doctor can see inside by using a handheld ophthalmoscope. However, after chemical injuries, a whitish, hazy area can appear in the clear part of the cornea. This can block clear vision, and it may prevent your doctor from seeing inside the eyeball through the pupil. If any significant damage has occurred, your doctor probably will recommend that you see an eye doctor (ophthalmologist) for a more complete inspection and vision testing.

Expected Duration

How long symptoms last depends on the type of chemical and the amount that has gotten into the eye.

Prevention

To prevent chemical damage to the eye, wear protective goggles whenever working with chemicals.

If your eye is exposed to chemicals, the most important way you can limit the damage is to start flushing the eye with water immediately. Use a strong steady stream of clean water. Arrange for immediate evaluation by a doctor. Continue the flushing until you are ready to go.

Treatment

Chemical eye injury required immediate medical care. But even before you arrange transportation to an emergency department, you should begin to rinse the eye with a continuous stream of water as soon as possible. It is best to use cool running water and to continue to rinse for at least 10 minutes. Some industrial locations have special fountains for washing eyes. If a fountain is not available, open your eyelids with your fingers and hold your head under a faucet. Allow water to run from the bridge of your nose outward across the eye so you don't expose the other eye to the chemical you are rinsing out. If both eyes are affected, you can either alternate sides or allow the water to flow over both eyes at once.

If you can't put your eye under a faucet, have someone help you. You can lie down on your side or hold your head sideways over a sink, and your helper can pour water from a cup across your eye while you hold the eyelids open.  Eye irrigation should continue during transport to the emergency department.

If you are wearing contact lenses, do not try to remove them before washing your eye. If the lens is still in your eye after several minutes of flushing with water, you should try to remove it.

Do NOT rub your eyes, even after flushing them with water.

A doctor should evaluate every chemical eye injury. The doctor will usually start irrigating the eye using a saline solution. He or she probably will apply anesthetic drops to the eye before rinsing it. The eyelids may be held open with a gentle instrument. After a complete rinse, your doctor will test the pH (acidity) of the eye. He or she will continue rinsing the eye until the pH is normal or near normal. In some cases, particularly after severe alkali burns, rinsing may need to be continued for as long as 24 hours. The doctor places a soft tube in the eye that connects to a bag of sterile saline solution (similar to an intravenous set up).

When the rinse is complete, the doctor will examine the eye and remove any foreign particles. He or she also may touch the cornea with a small instrument called a tonometer to check the pressure inside the eyeball. This is the same test used to screen for glaucoma. He or she will put drops into your eye to dilate the pupil. This not only allows the doctor to do a more complete eye examination, but it also can reduce pain by preventing subtle movements by the eye muscle that surrounds your pupil. When your eye is injured, those subtle movements can be painful. In severe cases, areas of dead tissue or chemical contaminants will need to be removed from the eye.

Antibiotic ointment will be put into your eye to prevent infection, and a topical steroid may be used to reduce inflammation. If the eye's internal pressure is elevated, the doctor also will prescribe eye drops to lower the pressure and prevent glaucoma. The eye usually will be bandaged with a patch that places slight pressure on the eye to keep it closed. If the injury is serious, you may have to be hospitalized so that health care professionals can monitor the pressure in your eye and the healing of the cornea, the transparent part of the eyeball that lets light in.

When To Call a Professional

Chemical injury to the eye is serious and can threaten your vision. Seek immediate emergency medical care (after you have rinsed the eye) any time an eye is exposed to a chemical.

Prognosis

The outlook for recovery from chemical injury varies depending on the nature and extent of the exposure. Most people recover completely. However, possible complications include glaucoma, damage to the cornea and dry eye syndrome. In the most severe cases, chemical exposure can lead to blindness or loss of the eye.

Additional Info

American Academy of Ophthalmology
http://www.aao.org

American College of Emergency Physicians (ACEP)
http://www.acep.org/