In any chemical or thermochemical eye injury, irrigation starts before history, acuity or slit lamp. Instil topical anaesthetic, hold the lids open and irrigate with at least one to two litres of saline or Ringer's lactate, or clean tap water if nothing else is to hand. Evert the upper lid, double-evert if possible, and sweep the fornices to remove retained particles — alkali particles keep burning. Check the pH with litmus paper and continue until it is neutral, then recheck after 20 minutes. Only then assess acuity, limbal ischaemia and grade.
- Start irrigation immediately, before taking a history or measuring acuity.
- Use at least one to two litres, and topical anaesthetic so the patient can tolerate it.
- Evert the lids and sweep the fornices to remove particles.
- Irrigate until the pH is neutral, and recheck after 20 minutes.
Why it matters
Minutes of delay and retained particles drive the limbal damage that leads to lifelong visual loss.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ophthalmology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free