Prolonged irrigation with Normal Saline (or water if Normal Saline is not available) is the mainstay of immediate treatment of ocular chemical burns. Irrigation should commence as soon as possible and continue until – all chemical or alkali has been washed out (usually at least 15 minutes).
All patients with facial burns are at risk of ocular damage. The blink reflex is strong and significant primary ocular injury surprisingly uncommon. All patients with facial burns should have an ocular examination consisting of:
- Visual acuity examination
- External ocular examination
- Fluorescein staining
If there is evidence of acute ocular burn (corneal cloudiness or fluorescein staining) then prophylactic antibiotic ointment (chloramphenicol ointment) should be applied and the eye padded (if possible).
Patients with full thickness lid burns are particularly at risk of late lagophthalmos, corneal exposure and secondary keratitis and visual loss (25).
The following patients should be referred for ophthalmic care:
- Any patient with acute corneal injury (cloudy or opaque cornea or fluorescein staining) or visual loss.
- All patients with full thickness lid burns (at risk of late exposure).
- Any patients with lagophthalmos (incomplete eye closure).