Polypharmacy and anticoagulation affecting periocular skin injury
Support needs
Home drop administration reliability
Earlier admission if poor self care capacity
Pediatrics
Cooperation and sedation
Intranasal midazolam for irrigation facilitation if needed
0.2 mg per kg intranasal
Maximum 10 mg
Procedural sedation if irrigation impossible otherwise
Injury patterns
Laundry detergent pods as high risk alkali exposure
Disposition considerations
Lower threshold admission for frequent drops
Mandatory ophthalmology follow up arrangement
Background
Epidemiology
Exposure settings
Household cleaners and detergents
Industrial alkali agents
Assault exposures pepper spray
High risk agents
Ammonia
Lye sodium hydroxide
Lime cement plaster
Hydrofluoric acid
Pathophysiology
Alkali injury mechanisms
Saponification of cell membranes
Deep penetration through stroma
Limbal stem cell injury and ischemia
Acid injury mechanisms
Protein coagulation limiting penetration
Surface epithelial necrosis
Complications
Corneal scarring and neovascularization
Persistent epithelial defect
Corneal melt and perforation
Symblepharon and fornix shortening
Secondary glaucoma
Cataract
Limbal stem cell deficiency
Therapeutic Considerations
Irrigation as definitive early therapy
Earlier pH normalization linked to better outcomes
Limbal ischemia as prognostic marker
Greater ischemia associated with worse vision prognosis
Steroid timing balance
Early inflammation control
Avoid prolonged use without close monitoring
Anti-collagenase and collagen support
Doxycycline and ascorbate to reduce stromal melt
Evidence grading use
ACEP Level C for immediate irrigation as standard of care based on consensus
Class I recommendation for immediate irrigation based on expert consensus
Patient Discharge Instructions
copy discharge instructions
Discharge plan
Prescribed eye drops and ointment use exactly as directed
Preservative free artificial tears frequent use
Avoid rubbing the eye
No contact lenses until cleared
Protective eyewear as needed
Follow up
Ophthalmology appointment within 24 hours
Earlier reassessment if worsening symptoms
Return to ED immediately
Decreased vision
Increasing pain
Increasing redness or swelling
New photophobia
Persistent vomiting or severe headache
Drainage or pus
Inability to keep drops in due to pain or swelling
References
Clinical guidelines and key sources
Core guidance
American Academy of Ophthalmology guidance on chemical injuries and ocular burns
Irrigation until physiologic pH
Particulate removal with lid eversion and fornix sweep
Roper Hall classification for ocular burns
Prognosis stratified by corneal haze and limbal ischemia
Dua classification for ocular burns
Prognosis stratified by limbal clock hours and conjunctival involvement
Evidence and consensus
Emergency medicine consensus for immediate irrigation without delay
ACEP Level C
Class I recommendation by expert consensus
Ophthalmology literature on adjunctive therapy
Early topical steroids short course for inflammation control
Doxycycline and ascorbate for stromal melt risk reduction
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.