If you haven’t read my earlier post about simple foreign body removal from the eye please do so since a lot of the material covered will be similar. However, treating a chemical or fine particle injury to the eye is very different. Hence this writeup. Here, there’s nothing physical in the eye to remove but the patient is still in significant pain. I can remember specifically one patient who got a face-full of an unknown powder which classically went right around his glasses and into his eyes causing significant pain. He walked in with both eyes injected and photophobia. Here’s the basic run down of what we did and why:
Disclaimer: This guide is to be used solely by licensed health care professionals (or those training directly under them) and expresses thoughts of myself only and is not a reflection of any institution or healthcare establishment.
- Get a baseline visual acuity & history. Specifically, what was the mystery chemical?
- Call the company and get a material safety data sheet (MSDS) faxed to you immediately! This multipage document has everything: chemical name & synonyms, hazards, first aid measures, etc. Obtaining this document is your treasure map. It will tell the clinician exactly what to do if exposed and following this to the “T” is key. Here’s a sample MSDS for graphite powder.
- Obtain a baseline pH. Treating the eye is all about chasing the pH. The eye’s normal pH is ~7. Not acidic, not basic. To determine this cut a strip of pH paper, expose the patient’s eye and touch it to either the sclera (white) or inside the lower lid.
- Numb the eye with 2 drops of Tetracaine and then visualize all corners of the eye by manipulating both eyelids while having the patient look around.
- Flush time! Two ways of doing this.
- As joked above in the top photo, have the patient physically hold their own eyelids open as they look into a eye wash station/sink for ~15 minutes. This was the method we learned in high school/college. Problem is most people find it difficult, if not impossible, to keep their eyes pried open for any extended period of time. Also, a lot of emergency rooms just don’t have these. Now what?
- We used the funkiest contraption and it worked flawlessly! Hang a bag of either Normal Saline or Lactated Ringers and attach a line splitter and 2 Morgan Lenses (These look like contact lenses with rubber tubes attached to them). Tape green Meri-Ducts to both outside edges of the patient’s eyes (these capture runoff water and direct it off the patient’s face into buckets on the floor, hint hint). Our site did something unique in that it injected several mL’s of Lidocaine into the Saline bag to keep the eyes numb during flushing (since your initial Tetraicaine will be instantly washed away). Finally place the patient’s face up, open your fluids wide open, retract their eyelids and insert the Morgan Lenses. Have the patient close their eyes around them and wait. The patient should feel instant relief while sitting back comfortably. But it does look freaky!
- After 2 Liters of fluids, remove the Morgan Lenses and give your patient a 2-minute break. Ask how their eyes feel and request they blink continuously to flush out excess saline/LR solution before rechecking their pH. If the number comes back ~7, congrats, proceed to the next step! If not, repeat a Liter-by-Liter flush of their eyes until the pH is ~7. We once had to flush a guy’s eye out with 9 LITERS.
- Once completely, remove everything and thoroughly examine all corners of the eye again. Remove any remaining particles (particularly in the medial epicanthal fold) by sterile Q-tips.
- As with the foreign body removal, stain the eye with fluorescein and use UV light/slit lamp visualization to determine if any corneal abrasion is present.
- Final visual acuity exam
- Provide Refresh lubricating eyedrops
And that’s it! Hope this was interesting for some and informative for all. Coincidence, maybe, but I ran across the coolest picture of an eye I’ve ever seen online this week. It was a keratoprosthesis, or artificial cornea! Obviously didn’t know that was a thing. IG Link.