Chemical Eye Injury
Objective: Start eye irrigation on scene for a chemical splash and keep it going. Alkali keeps burning longer than acid. Do not delay the flush for a perfect eye exam.
Why this matters
The patient may ask for a dressing and a clinic visit. Alkali, such as drain cleaner, lime, or cement, keeps damaging the cornea after you leave. Acid damages the eye too, but alkali tends to keep burning. Start a large-volume flush now. Do not delay it for a vision test.
- Flush now with the clean water or saline you have. Remove contact lenses if they come out easily. An irrigation lens is usually an emergency-department tool. Do not wait for one. Do not pour a household chemical into the eye to "neutralize" it.
- Do not dig under the eyelid for a stuck contact. Do not delay the flush to search for it.
- Bring the container if it is safe to do so. Call poison control or follow your protocol.
- Flush now with water or saline.
- Contacts come out if they come easily.
- No household chemicals go in the eye.
Clinical sequence
- Flush with clean water or saline now. Remove contacts if they come out easily. Do not wait for an irrigation lens, a pH strip you do not carry, or a perfect visual-acuity exam. Do not pour vinegar, baking soda, or another household chemical into the eye.
- Keep irrigating during transport if the patient can tolerate it. Do not stop only because they can still read.
- Bring the container if it is safe. Contact poison control. Go to a hospital that can keep irrigating and examine the eye.
Teaching points
- Alkali is worse than acid for ongoing damage. In the field, both still get the same treatment: immediate irrigation.
- Start now. Do not delay irrigation for a pH strip you do not carry or for a perfect vision exam.
- Keep irrigating during transport if the patient tolerates it.
- Do not neutralize with another chemical. Vinegar in an alkali burn is a second chemical injury. Use water or saline only.
Common errors
- Placing a dry patch and waiting while the chemical keeps burning.
- Trying to neutralize the chemical with another chemical.
- Skipping irrigation because the patient can still read.
Practice
One-minute check
Drain cleaner has splashed one eye and the patient is screaming. Say the first 30 seconds. Include what you flush with and what you will not put in the eye.
Related: Poison center thinking.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; your protocol decides
- America’s Poison Centers — immediate irrigation; do not neutralize with another chemical
- CDC ATSDR Medical Management Guidelines for chemical exposures — irrigate, then poison-center or protocol; neutralizing agents are not a field method
- Ophthalmology and poison-center teaching: copious irrigation is the field intervention that changes outcome.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.