2. Eye irrigation is used to flush particles and harmful
chemicals from the conjunctiva and cornea. Eyelid
eversion is used to expose the superior palpebral
conjunctiva and fornix, so that foreign matter can be
identified in these areas.
3. Indications
•Chemical injury to the eye (caustic chemical burns are a
medical emergency; irrigation should begin as soon as
possible, with on-site flushing with whatever water is
available, even before medical help arrives)
•Removal of small particulate matter from the eye
•Treatment of foreign body sensation when no particulates
are visible (sometimes successful)
INDICATIONS-
.
4. Contraindications
Absolute contraindications:
•None
Relative contraindications:
•If eye perforation is suspected, irrigation should be deferred until formal eye
examination can be done. If the cornea may have a deep injury or foreign body,
irrigation using a scleral lens may cause further injury and should not be done.
Irrigate the eye manually, gently, and very carefully.
C/I -
5. POSITIONING -
Positioning
•Place the patient supine on the bed or stretcher.
•Hang bags of saline irrigation fluid several feet above the patient’s head (proper fluid flow depends
on this height).
•Place a plastic drainage basin under the patient’s eye to collect the irrigation fluid and towels on the
stretcher.
•An assistant may be used to retract the eyelids during irrigation and should stand on the opposite
side of the stretcher.
6. CONSIDERATIONS -
.
Additional Considerations
•Patients exposed to chemicals may have other serious chemical burn injuries in addition
to ocular burns. Ocular burns should be treated simultaneously with treatment of these other
serious injuries.
•Request emergency ophthalmologic consultation for serious ocular burns, especially those
involving deep corneal injury, but do not delay irrigation while awaiting the ophthalmologist.
•If you are unsure about the severity of a chemical ocular injury, proceed with irrigation of the eye.
7.
8.
9.
10.
11. •After irrigation is complete, evert the upper eyelid, to
ensure that there are no residual deposits in the superior
conjunctiva.
•First, press gently on the superior part of the upper lid
with a cotton-tipped applicator. Then, manually lift the
upper lid margin, folding it backward over the applicator
(ie, upward and backward toward the patient’s forehead).
•Hold the everted eyelid in place by placing the applicator
over the everted conjunctiva.
•Particularly if a foreign body or bodies are suspected,
expose the superior fornix by using double eyelid eversion
(ie, first everting the eyelid and then inserting a swab
under the everted eyelid and lifting it up until the fornix is
visible)
•Sweep both the inferior and superior fornices to remove
any visible particles as well as residual particles that
cannot be seen.
EYELID EVERSION -
12. AFTERCARE
Do an ophthalmologic examination, including assessment of visual
acuity, measurement of intraocular pressure, and slit-lamp examination of the
cornea and conjunctiva with fluorescein staining, to assess for corneal
abrasion.
When necessary (eg, severe chemical burns), obtain ophthalmologic
consultation for continuing care or 24-h follow-up care.
Prescribe lubrication (preservative-free artificial tears and ointment) and
topical antibiotics (eg, moxifloxacin 0.5% drops tid for about 3 days) for
patients with mild corneal damage resulting from minor chemical exposures.
Consider using an eye patch or systemic analgesics to help alleviate pain, as
well as a cycloplegic (homatropine 5% or cyclopentolate 1% twice daily;
avoid phenylephrine because it can cause vasoconstriction and increase
ischemia).
Instruct the patient to return to the emergency department within 24 hr if
symptoms fail to improve or worsen.
13. The cornea or conjunctiva may be mechanically abraded by the tip of the IV tubing, by the scleral
lens, or by an irrigating stream pointed directly at the cornea.
COMPLICATIONS -
