Chemical Burns Flashcards
When is the only time VA should not be performed first?
When there is a chemical splash in the eyes
-the eye needs to be immediately irrigated in order to minimize conj and corneal scarring and reduced vision
What are the acceptable eye washes we can use for a chemical burn
Saline
Ringers lactate
Non-sterile water
How long do you irrigate an eye with a chemical splash?
Until there is a neutral pH in the inferior fornix
-immediately irrigate until the pH of the inferior fornix is neutral
White vs red eye from a chemical splash
White is more worrisome
-blanching is a sign of ischemia (interrupted blood flow in the conj and episcleral vessels); this is very concerning, especially if blanching occurs at the limbus where the corneal stem cells are located
Which is worse, acidic or alkaline burns
Alkalis burns are worse because they raise the tissue pH, causing a breakdown of fatty acids in the cell membrane that allows for faster corneal penetration (often less than 1m)
Examples of alkali agents
Anything ending in hydroxide Lye, drain cleaner, lime, cement, plaster, mouthwash, flares, fireworks Ammonia Household bleach Airbag residue
Acidic examples
Anything ending in acid
Glass polisher, industrial cleaners, battery acid, fertilizer, detergent
Sweeping the fornices with a CTA indications
Only may be necessary if persistent non neutral pH occurs. Double lid eversion may be indicated in order to remove particles deep in the fornix
Symblepharons and chemical splash
Adhesions to the bulbar and palpebral conjunctiva. These adhesions should be broken to prevent entropion, trichiasis, and corneal damage. A scleral shell can be used to maintain the fornices
Treatment for chemical burns
After irrigation
Similar to corneal abrasions
- PFATs Q1H
- ABX Q2H (if no eye patch)
- steroids Q1-2H
- cycloplegics
What is contraindicated in someone with a chemical burn
Phenylephrine
Pressure patch
What is a combination of neomycin, polymyxin B, and dexamethasone
Maxitrol
An abx ointment without any steroid in it
Erythromycin
Blephamide
Sulfacetamide and prednisone acetate
Tobrex
Tobramycin without steroids
