A patient arrives in the emergency department and reports splashing concentrated household cleaner in his eye. Which of the following nursing actions is a priority?
A. Irrigate the eye repeatedly with normal saline solution.
B. Place fluorescein drops in the eye.
C. Patch the eye.
D. Test visual acuity.
Correct Answer: A. Irrigate the eye repeatedly with normal saline solution.
Emergency treatment following a chemical splash to the eye includes immediate irrigation with normal saline. The irrigation should be continued for at least 10 minutes. Immediate irrigation with copious amounts of an isotonic solution is the mainstay of treatment for chemical burns. Never use any substance to neutralize chemical exposure as the exothermic reaction can lead to secondary thermal injuries. Irrigation should continue until the pH of the eye is between 7.0 to 7.4 and remains within this range for at least 30 minutes after the irrigation has been discontinued.
Option B: Fluorescein drops are used to check for scratches on the cornea due to their fluorescent properties and are not part of the initial care of a chemical splash. A topical anesthetic such as tetracaine can be applied directly to the eye, or 10 mL of 1% lidocaine can be added to a liter of irrigating fluid, taking care not to reach a toxic dose if copious irrigation is required.
Option C: Patching the eye would not remove the chemical. Severe burns may require upwards of ten liters of irrigation. Irrigation should be gentle, and care should be taken to avoid direct irrigation to the cornea to prevent further injury. Use of a commercial irrigation lens such as a Morgan lens may be helpful.
Option D: Following irrigation, visual acuity will be assessed. Ocular burns, particularly any chemical burns with corneal clouding or abrasions, should have prompt ophthalmology evaluation. Topical antibiotic ointment and possibly topical steroids may be prescribed for both chemical and thermal burns, but topical steroids should only be prescribed in consultation with an ophthalmologist.