Chemical Burns

Question 1

When is the only time VA should not be performed first?

Answer 1

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

Question 2

What are the acceptable eye washes we can use for a chemical burn

Answer 2

Saline
Ringers lactate
Non-sterile water

Question 3

How long do you irrigate an eye with a chemical splash?

Answer 3

Until there is a neutral pH in the inferior fornix

-immediately irrigate until the pH of the inferior fornix is neutral

Question 4

White vs red eye from a chemical splash

Answer 4

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

Question 5

Which is worse, acidic or alkaline burns

Answer 5

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)

Question 6

Examples of alkali agents

Answer 6

Anything ending in hydroxide 
Lye, drain cleaner, lime, cement, plaster, mouthwash, flares, fireworks
Ammonia
Household bleach
Airbag residue

Question 7

Acidic examples

Answer 7

Anything ending in acid

Glass polisher, industrial cleaners, battery acid, fertilizer, detergent

Question 8

Sweeping the fornices with a CTA indications

Answer 8

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

Question 9

Symblepharons and chemical splash

Answer 9

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

Question 10

Treatment for chemical burns

Answer 10

After irrigation

Similar to corneal abrasions

• PFATs Q1H
• ABX Q2H (if no eye patch)
• steroids Q1-2H
• cycloplegics

Question 11

What is contraindicated in someone with a chemical burn

Answer 11

Phenylephrine

Pressure patch

Question 12

What is a combination of neomycin, polymyxin B, and dexamethasone

Answer 12

Maxitrol

Question 13

An abx ointment without any steroid in it

Answer 13

Erythromycin

Question 14

Blephamide

Answer 14

Sulfacetamide and prednisone acetate

Question 15

Tobrex

Answer 15

Tobramycin without steroids

Question 16

FML

Answer 16

Fluoromethalone