Caustic keratoconjunctivitis: Difference between revisions
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==Treatment== | ==Treatment== | ||
# | #Anesthesia | ||
# | ##Apply topical anesthesia (e.g. tetracaine) | ||
## | #Irrigation | ||
##Treat until pH is 7. | ##Apply for at least 30min (1-2L) or at least 40min (4L) for alkali exposure | ||
##Perform immediately and before any examination | |||
##NS or LR works best | |||
##Treat until pH is >7.4 30min after the last irrigation | |||
###Avoid testing pH of the irrigation fluid (wait few min before checking ocular fluid) | ###Avoid testing pH of the irrigation fluid (wait few min before checking ocular fluid) | ||
## | #Remove particulate matter with cotton applicator | ||
# | #Measure acuity and IOP (may be increased if trabecular meshwork has been damaged) | ||
# | #Cycloplegic for pain control | ||
#Severe exposures may require anterior chamber irrigation | ##Avoid phenylephrine | ||
#Abx | |||
##Erythromycin ointment QID | |||
#Ophtho consultation for all but minor burns | |||
##Severe exposures may require anterior chamber irrigation | |||
==Disposition== | ==Disposition== | ||
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==Source== | ==Source== | ||
Tintinalli | *Tintinalli | ||
==See Also== | ==See Also== | ||
Revision as of 00:25, 27 October 2011
Background
- Chemical burn to eye
- Alkali injuries are more severe than acidic injuries
Treatment
- Anesthesia
- Apply topical anesthesia (e.g. tetracaine)
- Irrigation
- Apply for at least 30min (1-2L) or at least 40min (4L) for alkali exposure
- Perform immediately and before any examination
- NS or LR works best
- Treat until pH is >7.4 30min after the last irrigation
- Avoid testing pH of the irrigation fluid (wait few min before checking ocular fluid)
- Remove particulate matter with cotton applicator
- Measure acuity and IOP (may be increased if trabecular meshwork has been damaged)
- Cycloplegic for pain control
- Avoid phenylephrine
- Abx
- Erythromycin ointment QID
- Ophtho consultation for all but minor burns
- Severe exposures may require anterior chamber irrigation
Disposition
- Admit all pts w/ corneal haziness or opacity or limbal ischemia (paleness at limbus)
- Discharge w/ 24hr f/u if pt only has corneal epithelial injury (fluorescein uptake)
Prognosis
- After irrigation perform complete eye exam
- Prognosis determined by extent of injury at limbus and area/depth of injury to cornea
Source
- Tintinalli