Warning

Audience

  • Highland Health and Social Care Partnership
  • Primary and Secondary Care

Management

Immediate treatment (and neutralisation of pH)

  • Test pH;
  • Instill topical anaesthetic (Proxymethacaine,Bupivacaine or Tetracaine),
  • Insert a speculum
  • Irrigate with at least 2L of Normal saline or water through IV giving set (including into the fornices) until normal pH is restored

Inspection

  • Evert the lids (if possible), inspect lids and fornices and remove any particulate material with a cotton bud (e.g. lime, cement)

pH testing

  • Test pH at the end of irrigation and 5 min after.
    • If pH neutral/near neutral (compare to other eye if necessary), then begin examination and history taking and initiate further treatment (see below). Recheck pH after 20 mins
  • If pH abnormal, repeat irrigation cycle with another 2L until pH normal

Examination

  • Record visual acuity and pupil reactions
  • Look for abnormal whitening of conjunctival vessels adjacent to cornea (limbal ischaemia)
  • Check for corneal/conjunctival abrasions with fluorescein

Further treatment

  • Topical antibiotics: Chloramphenicol eye drops 4 times per day
  • Topical cycloplegia:Cyclopentolate 1% 3 times per day
  • Topical steroids: Dexamethasone 0·1% 4 times per day
  • Topical lubricants: Celluvisc 1% or Xailin gel 6 x a day and Xailin Night ointment at night
  • Oral analgesia as required
  •  Consider admitting to NTC Ophthalmology if severe injury (extensive corneal abrasion and limbal ischaemia)
  • Review by Ophthalmologist same day or following morning if out of hours

Abbreviations

NTC: National Treatment Centre

Last reviewed: 14/02/2023

Next review date: 28/02/2026

Author(s): Ophthalmology Review Group.

Version: 1.1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Dr T Leslie, Consultant Ophthalmologist.

Document Id: TAM553

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