A 68-year-old woman presents to urgent care after accidentally splashing household cleaning solution into her right eye while cleaning her bathroom. She immediately experienced burning, tearing, and blurred vision in the affected eye. She did not rinse her eye at home and came directly to the clinic. She denies trauma to the eye, loss of consciousness, or other injuries. On physical examination, her vital signs are stable, extraocular movements are intact, and her pupils are equal, round, and reactive to light. She has no visible foreign body or laceration and is experiencing redness and tearing of the right eye on inspection. Visual acuity is mildly decreased in the right eye compared to the left.
Which of the following is the most important initial step in managing a patient with a chemical splash injury to the eye?
- Begin immediate irrigation of the eye
- Measure intraocular pressure
- Instill topical antibiotic drops
- Refer immediately to the emergency department
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Answer: a. Begin immediate irrigation of the eye.
You knew that the best management for this patient, given the presentation, was to immediately irrigate the affected eye. After you applied topical anesthetic drops for comfort and checked the pH of her injured eye (alkaline with pH 9), you positioned her comfortably with her head tilted toward the affected side and towel underneath her. Using a large syringe, you irrigated the eye with normal saline, making sure the fluid bathed the entire ocular surface and under the eyelid. At regular intervals you checked the pH until it returned to neutral (pH 7-7.5). After 20 minutes of irrigation, you rechecked the patient’s visual acuity, noting that she had improved comfort and vision. The patient was stable for discharge from urgent care with instructions for at-home care using artificial tears and instructed to avoid rubbing the eye, along with close outpatient follow-up.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
