In any chemical or thermochemical eye injury, the first and most important treatment is immediate, copious irrigation, started before visual acuity or a detailed history if necessary. Particles lodged in the fornices keep releasing chemical until removed.
After irrigation, check the pH, evert the upper lid to sweep the fornices, and grade the injury by limbal involvement, which guides prognosis and the need for early surgical support such as amniotic membrane.
- Start irrigation immediately with saline or clean water, for at least 15–30 minutes.
- Check pH after irrigation and continue until it is neutral.
- Double-evert the upper lid and sweep the fornices for retained particles.
- Grade limbal involvement and refer severe burns urgently to a cornea service.
Why it matters
Minutes of delay in irrigation can decide whether the limbus survives.
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