General Medical Information

Burns

Jean Edwards Holt

An emergency that often comes to medical attention too late is chemical injury. Many substances are accidentally instilled in the eye, and most of these are of no consequence. Serious alkali or acid burns are emergencies. In the first few minutes, the solution must be diluted with any liquid available. It is not necessary to spend time attempting to neutralize the solution—immediate and profuse dilution is extremely important. Copious irrigation should be performed for 5 minutes, the eyelids should be held forcefully apart during irrigation. The patient can be held over a drinking fountain or under a faucet. Topical anesthetic usually is needed to remove particulate chemical matter from the eye. If lid spasm is severe, a selective facial nerve block may be needed to keep the eyelids open. After the diagnosis is made and initial treatment completed, an additional 20 minutes of continuous irrigation with balanced salt solution or Ringer solution, with a continuous intravenous drip, should be undertaken. Cycloplegic and antibiotic eyedrops usually are administered, and a sterile eye patch is gently applied. Thermal or flash burns of the eye and eyelid are managed with the same general measures as other skin burns. The ocular sequelae of chemical burns can cause total blindness. Damage to the eyelids from chemical or thermal burns usually causes severe cosmetic disfigurement, permanent tearing, exposure keratitis, and corneal ulceration or perforation.