Template:Caustic ocular exposure managment: Difference between revisions
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*Anesthesia | *Anesthesia | ||
**Topical anesthetic (e.g. [[tetracaine]]) to help with discomfort. | **Topical anesthetic (e.g. [[tetracaine]]) to help with discomfort. | ||
**Other options include cycloplegics (e.g. [[atropine]], [[cyclopentolate]]), IV/IM/PO analgesics | **Other options include cycloplegics (e.g. [[atropine]], [[cyclopentolate]]), IV/IM/PO [[analgesia|analgesics]] | ||
*[[Antibiotics]] | *[[Antibiotics]] | ||
**[[Erythromycin]] ophthalmic ointment QID for minor burns | **[[Erythromycin]] ophthalmic ointment QID for minor burns | ||
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**[[Topical steroids]] - [[prednisolone]] 1% ophthalmic QID for 1 week<ref>Dohlman, C.H., F. Cade, and R. Pfister, Chemical burns to the eye: paradigm shifts in treatment. Cornea, 2011. 30(6): p. 613-4.</ref> | **[[Topical steroids]] - [[prednisolone]] 1% ophthalmic QID for 1 week<ref>Dohlman, C.H., F. Cade, and R. Pfister, Chemical burns to the eye: paradigm shifts in treatment. Cornea, 2011. 30(6): p. 613-4.</ref> | ||
**Limit topical steroid use to 10 days to avoid corneal breakdown.<ref>Donshik, P.C., et al., Effect of topical corticosteroids on ulceration in alkali-burned corneas. Archives of ophthalmology, 1978. 96(11): p. 2117-20.</ref> | **Limit topical steroid use to 10 days to avoid corneal breakdown.<ref>Donshik, P.C., et al., Effect of topical corticosteroids on ulceration in alkali-burned corneas. Archives of ophthalmology, 1978. 96(11): p. 2117-20.</ref> | ||
* | *Ophthalmology consultation for all but minor burns (Severe exposures may require debridement or other surgical intervention) | ||
Latest revision as of 16:07, 5 October 2019
Caustic Ocular Exposure Management
- Eye irrigation
- Immediate irrigation is the most important treatment for caustic ocular injury, and should be started before comprehensive evaluation
- Irrigate affected eye(s) with copious amounts of fluid (no consensus on volume or length of time)[1]
- NS, LR, or BSS (Buffered Saline Solution) preferred in the hospital setting[2], but tap water is acceptable, especially in pre-hospital setting.
- Goal is to remove caustic agent and restore normal ocular pH (7.0-7.2)
- Do NOT attempt to neutralize pH by adding base to an acidic burn or acid to an alkali burn
- Use of morgan lens or eyelid speculum will assist with getting more fluid in contact with cornea
- Remove particulate matter
- Evert both lids, remove any visible particulate matter with cotton-tipped applicator
- Anesthesia
- Topical anesthetic (e.g. tetracaine) to help with discomfort.
- Other options include cycloplegics (e.g. atropine, cyclopentolate), IV/IM/PO analgesics
- Antibiotics
- Erythromycin ophthalmic ointment QID for minor burns
- Topical fluoroquinolone for more severe burns
- Control inflammation
- Topical steroids - prednisolone 1% ophthalmic QID for 1 week[3]
- Limit topical steroid use to 10 days to avoid corneal breakdown.[4]
- Ophthalmology consultation for all but minor burns (Severe exposures may require debridement or other surgical intervention)
- ↑ Chau JP, Lee DT, Lo SH. A systematic review of methods of eye irrigation for adults and children with ocular chemical burns. Worldviews Evid Based Nurs. 2012 Aug;9(3):129-38.
- ↑ Herr RD, White GL Jr, Bernhisel K, Mamalis N, Swanson E. Clinical comparison of ocular irrigation fluids following chemical injury. Am J Emerg Med. 1991 May;9(3):228-31.
- ↑ Dohlman, C.H., F. Cade, and R. Pfister, Chemical burns to the eye: paradigm shifts in treatment. Cornea, 2011. 30(6): p. 613-4.
- ↑ Donshik, P.C., et al., Effect of topical corticosteroids on ulceration in alkali-burned corneas. Archives of ophthalmology, 1978. 96(11): p. 2117-20.