Chemical Burns
Emergency — immediate copious irrigation (15-30 min minimum, longer for alkali). Check pH before and after (goal: 7.0-7.2). Alkali burns worse than acid (liquefactive necrosis penetrates deeper). Morgan lens for continuous irrigation. Do not attempt to neutralize — just irrigate. Remove contact lenses if present.
Traumatic Injuries
Foreign body: do not rub, irrigate to remove. If embedded, do not remove — shield and refer. Corneal abrasion: fluorescein staining, antibiotic drops. Hyphema: blood in anterior chamber — bed rest, elevate HOB, no ASA/NSAIDs. Globe rupture: do not touch, shield only, NPO, urgent surgery.
Nursing Management
Assess: visual acuity, pupil response, eye movement, external exam. Document mechanism, time, chemicals. For burns: continuous irrigation, monitor pH. For trauma: shield eye, do not manipulate, keep NPO. Pain management. Tetanus prophylaxis. Report all eye emergencies to ophthalmology immediately.
Important Notes
- Chemical eye burns: immediate copious irrigation is the most important intervention — every minute counts. Alkali worse than acid.
- Never attempt to remove an embedded foreign body — shield the eye and refer to ophthalmology immediately.
Clinical Tips
- Check pH after irrigation of chemical burns — goal 7.0-7.2. Continue irrigation until pH normal for 30 minutes.
- Globe rupture: shield only, do not touch or manipulate, keep NPO — emergency surgery.
Summary
Ocular trauma requires immediate irrigation for chemical burns, shielding for globe rupture, and urgent ophthalmology referral for all serious eye injuries.
