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Immediate priorities
Time critical stabilization
Airway compromise from caustic ingestion or inhalation
If stridor or respiratory distress, airway management
If altered mental status, resuscitation bay
Immediate copious irrigation
Do not delay for history, acuity grading, or visual acuity
Continue until ocular surface pH normal
Analgesia and cooperation
Topical anesthetic to enable irrigation
Systemic analgesia if severe pain
Decontamination and pH targets
Irrigation algorithm
Immediate removal of contact lenses
Continuous irrigation during removal if needed
Particulate removal
Lid eversion
Fornix sweep with moistened cotton applicator
Lime or plaster particles removal
Irrigation fluid selection
Normal saline
Lactated Ringer
Tap water if nothing else immediately available
Irrigation method
Morgan lens if tolerated
Manual irrigation with eyelids held open if not tolerated
pH monitoring
Initial pH testing before irrigation if instant and does not delay
Recheck pH 5 to 10 minutes after stopping irrigation
Resume irrigation if pH not physiologic
pH target
Ocular surface pH 7.0 to 7.4
Stable pH after a pause off irrigation
Key concepts
Burn severity drivers
Alkali exposure
Rapid penetration
Progressive liquefaction injury
Acid exposure
Protein coagulation with barrier effect
Hydrofluoric acid as high risk exception
Time to irrigation as major outcome determinant
Delayed irrigation associated with worse vision outcomes
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.