Caustic keratoconjunctivitis

Background

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

Treatment

1. Topical anesthesia (e.g. tetracaine)
2. Copious irrigation in 15min intervals followed by pH check
   1. LR, NS, or 3% saline works best
   2. Treat until pH is 7.5-8.0 (check with pH strip)
      1. Avoid testing pH of the irrigation fluid (wait few min before checking ocular fluid)
   3. Alkali exposure requires minimum of 4L over 40min
3. Check IOP
4. Consider cycloplegic (e.g. atropine)
5. 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

1. After irrigation perform complete eye exam
   1. Prognosis determined by extent of injury at limbus and area/depth of injury to cornea

Source

Tintinalli

See Also

• Eye Algorithm (Main)
• Burns
• Caustics