View source for Template:Caustic ocular exposure managment

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===[[Special:MyLanguage/Caustic keratoconjunctivitis|Caustic Ocular Exposure Management]]=== <!--T:1-->

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*Eye irrigation
**Immediate irrigation is the most important treatment for caustic ocular injury, and should be started before comprehensive evaluation
**Irrigate affected eye(s) with copious amounts of fluid (no consensus on volume or length of time)<ref>Chau JP, Lee DT, Lo SH. A systematic review of methods of eye irrigation for adults and children with ocular chemical burns. Worldviews Evid Based Nurs. 2012 Aug;9(3):129-38.</ref>
**NS, LR, or BSS (Buffered Saline Solution) preferred in the hospital setting<ref>Herr RD, White GL Jr, Bernhisel K, Mamalis N, Swanson E. Clinical comparison of ocular irrigation fluids following chemical injury. Am J Emerg Med. 1991 May;9(3):228-31.</ref>, but tap water is acceptable, especially in pre-hospital setting.
**Goal is to remove caustic agent and restore normal ocular pH (7.0-7.2)
**Do NOT attempt to neutralize pH by adding base to an acidic burn or acid to an alkali burn
**Use of morgan lens or eyelid speculum will assist with getting more fluid in contact with cornea
*Remove particulate matter
**Evert both lids, remove any visible particulate matter with cotton-tipped applicator
*Anesthesia
**Topical anesthetic (e.g. [[Special:MyLanguage/tetracaine|tetracaine]]) to help with discomfort.
**Other options include cycloplegics (e.g. [[Special:MyLanguage/atropine|atropine]], [[Special:MyLanguage/cyclopentolate|cyclopentolate]]), IV/IM/PO [[Special:MyLanguage/analgesia|analgesics]]
*[[Special:MyLanguage/Antibiotics|Antibiotics]]
**[[Special:MyLanguage/Erythromycin|Erythromycin]] ophthalmic ointment QID for minor burns
**Topical [[Special:MyLanguage/fluoroquinolone|fluoroquinolone]] for more severe burns
*Control inflammation
**[[Special:MyLanguage/Topical steroids|Topical steroids]] - [[Special:MyLanguage/prednisolone|prednisolone]] 1% ophthalmic QID for 1 week<ref>Dohlman, C.H., F. Cade, and R. Pfister, Chemical burns to the eye: paradigm shifts in treatment. Cornea, 2011. 30(6): p. 613-4.</ref>
**Limit topical steroid use to 10 days to avoid corneal breakdown.<ref>Donshik, P.C., et al., Effect of topical corticosteroids on ulceration in alkali-burned corneas. Archives of ophthalmology, 1978. 96(11): p. 2117-20.</ref>
*Ophthalmology consultation for all but minor burns (Severe exposures may require debridement or other surgical intervention)
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