Caustic keratoconjunctivitis

Background

• Chemical burn to eye
• Alkali injuries are more severe than acidic injuries

Treatment

1. Anesthesia
   1. Apply topical anesthesia (e.g. tetracaine)
2. Irrigation
   1. Apply for at least 30min (1-2L) or at least 40min (4L) for alkali exposure
   2. Perform immediately and before any examination
   3. NS or LR works best
   4. Treat until pH is >7.4 when checked 30min after the last irrigation
      1. Avoid testing pH of the irrigation fluid (wait few min before checking ocular fluid)
3. Remove particulate matter with cotton applicator
4. Measure acuity and IOP (may be increased if trabecular meshwork has been damaged)
5. Cycloplegic for pain control
   1. Avoid phenylephrine
6. Abx
   1. Erythromycin ointment QID
7. Ophtho consultation for all but minor burns
   1. Severe exposures may require anterior chamber irrigation

Disposition

1. Admit all pts w/ corneal haziness or opacity or limbal ischemia (paleness at limbus)
2. Discharge w/ 24hr f/u if pt only has corneal epithelial injury (fluorescein uptake)

Prognosis

After irrigation perform complete eye exam. The prognosis is determined by the extent of injury at the limbus and area/depth of injury to cornea.

Source

Brodovsky SC, et al: Management of alkali burns: An 11-year retrospective review. Ophthalmology 2000; 107:1829-1835

See Also

• Eye Algorithm (Main)
• Burns
• Caustics