Chemical eye burn: irrigate first
- Emergency
After a chemical splash the eye is washed at once with any clean water, for 15 to 30 minutes or more, until the pH is neutral. History and acuity come after.
What it is
In a chemical burn the speed and amount of irrigation decide the outcome more than any drug. Alkalis (lime, cement, drain cleaners) penetrate deep and keep damaging after the exposure; acids cause more superficial burns. Whoever sees the patient first irrigates, before taking a history or measuring vision, and keeps going until the conjunctival pH is neutral.
How to recognise it
- Alkali agent (cement, lime, plaster, ammonia, caustic soda): usually the most severe.
- Pain, tearing, spasm of the lids and blurred vision after a splash.
- White, bloodless conjunctiva or limbus: ischaemia, a sign of a severe burn.
- Hazy or opaque cornea that hides the iris.
- Particles of lime or cement stuck in the fornices, which keep releasing alkali.
What to do at once
- Start irrigation immediately with whatever clean fluid is at hand: tap water if necessary, saline or Ringer lactate when available.
- Instil a topical anaesthetic drop to allow the eye to be opened; a lid speculum or lid retraction helps.
- Irrigate for at least 15 to 30 minutes, directing the flow into the fornices while the patient looks in all directions.
- Evert the upper lid, twice if possible, and sweep the fornices with a moist swab to remove particles.
- Wait 5 to 10 minutes and check the pH of the tear film with a test strip; keep irrigating until it is neutral.
- Only then measure visual acuity, stain with fluorescein and look at the limbus and corneal clarity.
- Never try to neutralise an alkali with an acid or the reverse.
Mistakes that cost sight
- Delaying irrigation to measure acuity or find a sterile solution costs tissue every minute.
- The pH can drift back after irrigation stops as the chemical leaches out of the tissues: recheck it.
- Severity is graded by corneal clarity and the share of the limbus that is ischaemic; a large ischaemic area destroys limbal stem cells.
Next step / Initial management
- Every chemical burn: ophthalmology the same day; alkali burns and any with corneal haze or limbal ischaemia as an emergency.
- Mild burns (clear cornea, no ischaemia): topical antibiotic, lubricants and a cycloplegic for pain, with review the next day.
- Moderate or severe burns: admission and specialist treatment (topical corticosteroids for the first days only, vitamin C, tetracyclines, amniotic membrane or limbal surgery).
- Monitor eye pressure, and treat burns of the face and airway that came with the same accident.
Test yourself
Think of the answer, then tap the question to see it.
What is the first step in a chemical eye burn?
Immediate copious irrigation with any clean water or saline, before taking the history or measuring vision.
When can irrigation of a chemical burn be stopped?
After at least 15 to 30 minutes and once the pH of the conjunctival sac, checked a few minutes after stopping, is neutral.
Why are alkali burns usually worse than acid burns?
Alkalis dissolve cell membranes and penetrate deep into the eye, so the damage continues after the exposure.
Connections
In Pharmacology2
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Ocular Burns (StatPearls Publishing (NCBI Bookshelf), 2026); Chemical Burns (StatPearls Publishing (NCBI Bookshelf), 2023).
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Representative model, for educational purposes only.