Chemical Eye Exposure: Immediate Irrigation Protocol and Red Flags

IMMEDIATE ACTION: Irrigate continuously for MINIMUM 15–30 MINUTES.

Step-by-Step Protocol

1. Start NOW: Don't delay for identification. Use any clean water (tap, bottle, shower, eyewash station).
2. Position: Head tilted toward affected side; prevent cross-contamination.
3. Eyelids: Hold open with fingers; rotate globe to reach fornices.
4. Contact lenses: Remove IMMEDIATELY (traps chemical).
5. Duration:
   • Acid: 15–20 min.
   • Alkali (lye, ammonia, cement): 30–60 min (penetrate deeper, cause liquefactive necrosis).
   • Unknown: 30 min minimum.
6. After irrigation: Urgent ophthalmology/ED evaluation — even if pain subsides.

Critical Do NOTs

• Rub eye (mechanical + chemical damage).
• Neutralize (heat from reaction worsens injury).
• Bandage (traps residual chemical).
• Use eye drops/ointments unless directed by clinician.

Red Flags for Emergent Ophthalmology

• Pain persisting >30 min post-irrigation.
• Vision change (blur, loss).
• Corneal opacity, epithelial defect (fluorescein uptake).
• Anterior chamber reaction (cells/flare, hypopyon).
• Perforation risk (Seidel test positive).

Alkali injuries are ophthalmic emergencies — early irrigation duration predicts visual outcome.