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# Chemical eye injury

A burn of the eye surface by an acid or alkali splash. It is a true eye emergency: rinsing with water at once is what saves sight.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Cornea](https://durgical.com/en/anatomy/cornea/)
- [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/)
- [Sclera](https://durgical.com/en/anatomy/sclera/)
- [Lens](https://durgical.com/en/anatomy/lens/)
- [Iris](https://durgical.com/en/anatomy/iris/)
- [Tear drainage](https://durgical.com/en/anatomy/lacrimal-canaliculus/)

## Why it happens

- [Chemical (toxic) cell injury: direct and after metabolism](https://durgical.com/en/general-pathology/chemical-cell-injury-direct-and-after-metabolism/)
- [Patterns of necrosis: coagulative, liquefactive, caseous, fat, fibrinoid, gangrenous](https://durgical.com/en/general-pathology/patterns-of-necrosis-coagulative-liquefactive-caseous-fat-fibrinoid-gangrenous/)
- [The eye wall: cornea, sclera, uvea and lens](https://durgical.com/en/histology/the-eye-wall-cornea-sclera-uvea-and-lens/)

## What it is

Damage to the [cornea](https://durgical.com/en/anatomy/cornea/), conjunctiva and eyelids caused by contact with an acid or an alkali. Alkali burns are usually the most severe. Immediate, prolonged irrigation is the key treatment.

## Who gets it

Mostly young working-age men, at work (construction, industry, agriculture) or at home with cleaning products. In Colombia, attacks with acid to the face and eyes are a recognised form of violence, and cement, lime and fertilisers are common causes.

## Causes

- Alkalis: lime, cement and plaster, ammonia, drain and oven cleaners (sodium hydroxide)
- Acids: battery acid (sulphuric), bleaching and cleaning products, industrial acids
- Assaults with acid
- Airbag deployment, fireworks and aerosol sprays

## Risk factors

- Work in construction, industry, laboratories or agriculture without eye protection
- Household cleaning products stored or mixed unsafely
- Young children with access to chemicals
- Interpersonal violence

## Pathophysiology

Alkalis saponify cell membrane lipids and penetrate quickly into the deeper cornea, the [anterior chamber](https://durgical.com/en/anatomy/anterior-chamber-of-eyeball/), the [iris](https://durgical.com/en/anatomy/iris/) and the lens, so damage continues after exposure. Acids denature and precipitate surface proteins, which forms a barrier that limits deeper spread, so injuries are often shallower (hydrofluoric acid is an exception). The severity depends on the agent, its concentration, the contact time and how much of the limbal stem cells is destroyed.

## Classification

- Mild: corneal epithelial defect, no limbal ischaemia
- Moderate: corneal haze with partial limbal ischaemia
- Severe: opaque cornea and extensive limbal ischaemia (grading systems such as Roper-Hall or Dua)

## Symptoms and signs

- Intense eye pain, burning and tearing
- Red eye, swollen eyelids and difficulty opening the eye (blepharospasm)
- Blurred vision or loss of vision
- Light sensitivity and foreign-body sensation
- Whitened, porcelain-like conjunctiva and a hazy cornea in severe burns

## Red flags

- Alkali exposure (cement, lime, caustic soda), even if the eye looks only mildly affected at first
- A white, avascular limbus or conjunctiva: this sign means ischaemia, not a quiet eye
- An opaque cornea that hides the iris
- Raised intraocular pressure
- Burns of the face or airway in the same accident

## Diagnosis

**Clinical**
History of the agent, then irrigation BEFORE the full examination. After irrigation: visual acuity, slit-lamp examination with fluorescein to measure the epithelial defect, assessment of limbal ischaemia, eversion of the [eyelids](https://durgical.com/en/anatomy/superior-tarsus/) to find retained particles, and intraocular pressure.

**Tests**
Checking the tear-film pH with litmus paper before and after irrigation, until it returns to neutral (about 7.0–7.5).

**Imaging**
Usually not needed. Imaging of the orbit is used only when an associated penetrating injury or fracture is suspected.

## Differential diagnosis

- Thermal burn of the eye
- Corneal abrasion or foreign body
- Ultraviolet keratitis (welding, snow blindness)
- Open globe injury
- Allergic or irritant conjunctivitis

## Goal of treatment

Stop the chemical damage by restoring a neutral pH as fast as possible, then help the surface heal, control inflammation and pressure, and prevent infection, scarring and loss of the limbal stem cells.

## Treatment

**Acute**
Immediate, copious irrigation with water or isotonic solution at the scene and in the emergency room, after a topical anaesthetic, until the pH is neutral; particles are swept out of the fornices and the eyelids are everted.

**Medical**
Topical antibiotics, cycloplegics for pain, and topical corticosteroids early under specialist care; oral and topical vitamin C or tetracyclines in moderate to severe burns; drugs that lower intraocular pressure when it is raised.

**Procedure**
Bandage contact [lens](https://durgical.com/en/anatomy/lens/) or amniotic membrane applied over the eye surface to support healing in moderate and severe burns.

**Surgical**
In late or severe cases: limbal stem cell transplantation, release of adhesions between eyelid and globe (symblepharon) and corneal transplantation.

**Follow-up**
Daily checks of the epithelial defect, pressure and infection at first; nursing care focuses on irrigation, pain relief, eye protection and teaching about protective eyewear.

## Complications

- Corneal scarring, ulcer and perforation
- Limbal stem cell deficiency with vessels growing over the cornea
- Symblepharon and eyelid malposition
- Secondary glaucoma and cataract
- Dry eye and permanent vision loss

## Prognosis

Mild burns usually heal within days without sequelae. In severe alkali burns with extensive limbal ischaemia, the outlook for vision is poor despite treatment, and several surgeries may be needed.

## Prevention

- Safety goggles or a face shield when handling chemicals, cement or lime
- Eyewash stations in workplaces and laboratories
- Safe storage of cleaning products out of children's reach
- Legal and social measures against acid attacks

## Test yourself

Think of the answer, then tap the question to see it.

## What is the first step in managing a chemical eye injury?

Immediate, copious irrigation of the eye with water or isotonic solution, before any detailed examination, until the pH is neutral.

## Why are alkali burns of the eye usually worse than acid burns?

Alkalis saponify cell membranes and penetrate deep into the eye, while acids coagulate surface proteins that act as a barrier.

## How is the end of irrigation decided in a chemical eye injury?

By testing the tear-film pH with litmus paper until it is back in the neutral range and stays there a few minutes later.

## What does a white, avascular limbus mean after a chemical burn?

Limbal ischaemia, a sign of a severe burn with risk of stem cell loss and a poor visual outcome.

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## Related conditions

- [Corneal abrasion and ocular foreign body](https://durgical.com/en/conditions/corneal-abrasion-and-ocular-foreign-body/)
- [Keratitis and corneal ulcer](https://durgical.com/en/conditions/keratitis-and-corneal-ulcer/)
- [Open-angle glaucoma](https://durgical.com/en/conditions/open-angle-glaucoma/)
- [Cataract](https://durgical.com/en/conditions/cataract/)
- [Conjunctivitis](https://durgical.com/en/conditions/conjunctivitis/)
- [Uveitis](https://durgical.com/en/conditions/uveitis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Eye emergencies: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000054.htm) (MedlinePlus, US National Library of Medicine, 2026); [Corneal injury: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001017.htm) (MedlinePlus, US National Library of Medicine, 2026).

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Source: https://durgical.com/en/conditions/chemical-eye-injury/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/chemical-eye-injury/