Ocular injury due to foreign bodies and chemicals has the ability to cause ongoing discomfort and permanent injury to the eye. Flushing with water for a suitable period of time has the ability to reduce or eliminate further injury and damage.
Foreign body irritant due to:
- Dust
- Smoke particles
- Other foreign bodies that are on the surface of the eye
Ocular injury due to:
- Acid or solvent burns
- Gasoline
- Detergents
- Alkali burns
- Chemical splashes
- Oleoresin Capsaicum (OC), capsicum or pepper spray
- Penetrating eye injuries
- Suspected or actual rupture of the globe
- Use normal saline (NaCl 0.9%) preferentially, or clean, potable water if there is no saline available
- Irrigation solution should be tepid; too cold or hot could cause further damage to the eye and surrounding fluid.
- Minimise the application pressure. This should be enough to gently shower and flood the eye. Avoid high pressure at all times.
Patient
- Explain procedure to patient and gain consent where applicable
- Perform hand hygiene and don all relevant PPE
- Maintain aseptic technique throughout procedure
- Consider Ondansetron (as vomiting may cause an increase in intra-ocular pressure)
- Consider requirement for analgesia
- Place clean absorbent pad underneath patients head (ensure spinal immobilisation maintained if required)
- Position patient supine with 30° head elevation to reduce intra-ocular pressure (unless hypovolemic)
- Tilt patients head slightly towards side of affected eye (to ensure irrigation of irritant/ chemical is away from non-affected eye). If spinal immobilisation required or both eyes affected, maintain supine positioning and attempt to irrigate contents laterally
- Test temperature of irrigation fluid prior to irrigation (best to use room temperature)
- Ask patient to fix their gaze
Prepare the equipment
- Absorbent pads
- Combine dressing
- 1 litre NaCl 0.9%
- 20 ml syringe
Procedure
- For foreign body irritant:
- Draw up Normal saline (NaCl 0.9%) into 20ml syringe
- Open the eyelid/s (if possible), ensuring not to touch the conjunctiva with hands
- From no more than 5 centimetres away, irrigate saline into front surface of the eye and inside the lower eyelid
- Ask patient to move eye in all directions during irrigation
- For foreign body irritant use 20ml syringe to clear foreign body
- Absorbent pads / combine dressings can be placed next to patients’ cheek to absorb the irrigated fluid
- For chemical injury:
- Setup IV giving set using the 1 litre normal saline (NaCl 0.9%) bag
- Open the eyelid/s (if possible), ensuring not to touch the conjunctiva with hands
- From no more than 5 centimetres away, gently irrigate saline into front surface of the eye, under the upper eyelid and inside the lower eyelid.
- Ask patient to move eye in all directions during irrigation
- For chemical injury use IV giving set to for copious Irrigation as early as possible, for a minimum of 30 minutes. This should not delay transport.
- Absorbent pads / combine dressings can be placed next to patients’ cheek to absorb the irrigated fluid
Where eye irrigator is available*
*Staff must be trained and authorised in use.
- Locate the eye wash station
- Twist the irrigator clockwise to open the saline bottle
- Remove the dust cap on te applicator
- The head should be pointed downwards to assist with drainage and avoid spent fluid entering the bottle
- Hold the eye(s) open with the fingers
- Begin to flush the eyes
- Have the patient gently roll their eyes from left to right and up and down to be sure that all areas of the eyes are flushed
In the event of a chemical injury:
- flush for a full 15 minutes to allow appropriate dilution and clearance.
In the event of ongoing discomfort or injury:
- The patient should be referred to a specialist physician for follow up.
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