EyeTools Optometry Skills

197: A patient of mine phoned yesterday having being splashed with a chemical in her face some of which went into her eyes. She was in a panic and I didn’t know what to say. I advised her to go to an accident and emergency department at one of the local hospitals. Could I have done anything else?

Over my career, I’ve had two people run into my practice having had chemicals splash into their eyes. Of course, the level of potential injury depends on the nature of the chemical entering the eye. Some chemicals react so harshly with the eye that they can have catastrophic effects on the ocular surface and vision.

The first minutes after the chemical has entered the eye are crucial. What happens in these first few minutes determines the amount of damage and the level of vision at the end of treatment. It is essential that eye care specialists have a good sense of what first aid to offer in those first minutes.

Perhaps not surprisingly, the incidence of chemical eye injury is highest in men (ratio 3-8:1) of working age (typically 20-30 years), with two-thirds occurring at work. This is associated with poor use of protective eyewear and poor knowledge of first aid management

Sadly, assault accounts for one-third of severe injuries and causes more permanent damage due to the toxic nature of the chemicals used (e.g. ammonia) and reduced access to emergency treatment.

Alkalis account for two-thirds of injuries, with the resultant damage related to the rate of penetration of the ocular surface. Alkali chemicals are much more penetrative than acids.

If a patient phones or comes into the practice, ask them what first aid treatment they have applied. The eyes must be flooded with clean water or saline from a tap, hose pipe, or water bottle. By flooded I mean that the face, hair, and clothes become soaked and the floor drenched as so much water has been poured into the eyes. The application of water should continue for around five minutes. It might be that the chemical reaction causes the eyes to close. They must be prized apart in order to get the water in. Another person, if available, could help. It may be helpful to lie the patient when applying the water or saline. Contaminated clothing should be removed.

Once the first aid treatment has been completed,  the patient must go immediately to an accident and emergency department, where attempts can be made to identify the chemical and treatment initiated. Consider phoning ahead to alert the hospital staff that the patient is on their way, what has happened and the details of the first aid treatment you initiated. Note the patient details you have and your actions in the clinical records.

0 Comments

Submit a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

If you like EyeTools Questions of the Day…

Children’s Eye Examinations
How to Run a Successful Low Vision Clinic
How to Run a Successful Optometry Practice

EyeTools.Education

 

NEW WEBINARS ADDED REGULARLY – this is for:
– Optometry students
– Pre-registration and novice optometrists
– Optometrists returning to work
– Junior eye doctors
– Dispensing opticians and orthoptists preparing for refraction exams
– Contact lens opticians, clinical assistants and eyecare educators

Improve your optometry skills with introductory & specialist instruction videos, topical live & recorded expert webinars, presentations and book reviews.

Start with the first section, ‘Pre-refraction procedures’ free, then choose a monthly or yearly subscription. To see English captions, click the CC button on any video.