A chemical or thermochemical ocular burn is one of the few true eye emergencies where treatment must precede a full history and examination. Minutes of delay change the outcome.
Start immediate, copious irrigation with any available clean saline or water, and keep going; do not pause to measure acuity or take a detailed history first. Evert both eyelids and sweep the fornices to remove retained particulate matter, which is critical for lime, cement and calcium carbide, where solid particles keep releasing alkali. Check tear-film pH with litmus and continue irrigating until it is neutral and stable, typically around 7.0 to 7.4, then recheck after a few minutes.
Only then grade the burn (Roper-Hall or Dua), assess limbal and conjunctival ischaemia, and start intensive lubrication, a topical steroid, ascorbate and cycloplegia as indicated, with urgent referral for significant burns. Alkali burns are worse than acid because they penetrate deeper, so never undertreat an apparently quiet alkali injury.
- Irrigate immediately and copiously, before measuring acuity or taking a history.
- Evert the lids and sweep the fornices to remove retained particles, vital for lime and calcium carbide.
- Check pH and keep irrigating until it is neutral and stable (about 7.0 to 7.4), then recheck.
- Grade the burn, then start lubrication, topical steroid, ascorbate and cycloplegia, and refer severe burns urgently.
Why it matters
Immediate irrigation and particle removal do more to save the eye than anything that follows, and delay to take a history costs vision.
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