Cornea
Chemical Eye Injury
Also known as: chemical burn eye, alkali burn eye, acid burn eye, chemical eye injury, caustic eye splash, bleach eye, lime burn eye, cement eye injury
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Ocular injury from acid or alkali agents. The single most time-critical ophthalmic emergency — immediate and prolonged irrigation is the only treatment that changes outcome. Alkali burns (pH > 7) are more dangerous than acid burns because alkali penetrates deeper by saponifying cell membranes (liquefactive necrosis). Every minute of delay in irrigation worsens the prognosis. Irrigate before taking a history.
Recognition
Symptoms: what patients report
- Immediate severe burning eye pain.
- Profuse tearing.
- Blepharospasm — inability to open the eyes.
- Redness.
- Blurred vision.
- Exposure to identified chemical agent — acid (battery acid, vinegar, industrial), alkali (lime/plaster, cement, bleach, ammonia, oven cleaner).
Signs: what the examination shows
- Conjunctival hyperaemia — or blanching/ischaemia (worse prognosis in alkali burns).
- Corneal epithelial defect on fluorescein staining.
- Corneal oedema and haze (alkali burns).
- Limbal ischaemia: white, blanched limbus — indicates stem cell and vasculature destruction. Grade determines severity.
- Conjunctival necrosis and chemosis.
- pH paper testing: alkaline pH indicates ongoing alkali exposure.
- Anterior chamber reaction.
- In severe alkali burns: corneal melt, symblepharon formation, limbal stem cell failure.
What OptoGuide™ covers for chemical eye injury
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Trauma (chemical) — College of Optometrists CMG
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Correlation analysis of the clinical features and prognosis of acute ocular burns—exploration of a new classification scheme. Wang F, Cheng J, Zhai H, et al. Graefe's Archive for Clinical and Experimental Ophthalmology =
- Chemical Eye Injury: Pathophysiology, Assessment and Management. Dua HS, Ting DSJ, Al Saadi A, Said DG. Eye (London, England). 2020;34(11):2001-2019.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.