Caustic keratoconjunctivitis

Background

Chemical burn to eye

Treatment

1. Topical anesthesia (e.g. tetracaine)
2. Irrigate!!!
   1. until pH 7.0 (check with pH strip)
   2. alkaline exposure requires minimum of 4L over 40min
3. Check IOP
4. Consider cycloplegic (e.g. atropine)

• Alkali injuries are more severe than acidic injuries
• Treatment
  • Copious irrigation in 15min intervals followed by pH check
  • LR, NS, or 3% saline works best
  • Treat until pH is 7.5-8.0
  • Severe exposures may require anterior chamber irrigation
  • Avoid testing pH of the irrigation fluid (wait few min before checking ocular fluid)
• After irrigation perform complete eye exam
  • Prognosis determined by extent of injury at limbus and area/depth of injury to cornea
• Disposition
  • Admit all pts w/ corneal haziness or opacity or limbal ischemia (paleness at limbus)
  • Discharge w/ 24hr f/u if pt only has corneal epithelial injury (fluorescein uptake)

See Also

• Eye Algorithm (Main)
• Burns