In case of a chemical burn of the eye, pain occurs in and around the eye. Depending on how extensive the burn has been, the area around the eyes may also be affected (facial skin, eyelids). In order to accelerate the washing out of the irritant, the eye starts to water as a protective measure.
Within a very short time the cornea can become cloudy due to the destruction of the cells and lead to a reduction in vision (reduction in visual acuity). This can even lead to blindness of the eye. A whitish clouding of the eye can be seen. In addition, a spasmodic closure of the eyelids can occur. If the burns are more severe, there is a possibility that the patient will go into shock as a reaction to the injury and the pain.
It is particularly important to treat eye burns directly at the site of the accident in order to improve the course and chances of recovery. This should be carried out by those present without waiting for the doctor. A doctor should be called during the first aid measures or be on the way to an ophthalmological practice.
The eye must be rinsed out immediately. The eye should be rinsed with liquid for at least 15 minutes. In the best case, the eye rinsing is not interrupted until a doctor is present.
In principle, immediate rinsing with liquid is better than rinsing with distilled water only after a longer waiting period. Of course, it also applies here that no contaminated water should be used. The head of the accident victim is tilted to the side of the eye burn, so that the uninjured eye cannot additionally come into contact with the corrosive substance.
For the subsequent eye rinsing, the eyelids must be kept open against the resistance of the eyelid cramps. Then the irrigation fluid is poured into the eye from a height of about 10 cm. All neutral liquids in the surrounding area are suitable for rinsing the eye.
While the fluid is being rinsed into the eye, the patient must look in all directions of vision one after the other so that the rinsing fluid reaches all corners of the eye. In addition, the first aid worker should inspect all corners of the eye and look under the eyelids. In the course of burns and the processes that follow, such as the reaction of mortar with water, solid bodies are often deposited, which, if left on and in the eye, can lead to further damage.
If a person has got mortar, cement and other lime-containing substances in the eye, water must never be used as a rinsing liquid! In this case a doctor must be consulted immediately. Water (mineral water or tap water) or a buffer solution is best suited.
At the workplace, where dangerous substances are often handled, there is often a so-called eye shower. In an emergency and in the absence of the above-mentioned possibilities, other aqueous substances such as lemonade, beer, lukewarm or cold tea or coffee can also be used for rinsing. Milk, on the other hand, is unsuitable, as it can cause greater burns to the eye.
If there are still limescale particles in the eye, these can at best be carefully removed with a damp cotton swab. However, this should be avoided directly on the cornea (the transparent part of the front of the eye). During irrigation, a local anaesthetic, if present, can be dripped into the eye at shorter intervals to relieve pain.
After careful irrigation, the patient must be taken immediately to an ophthalmologist or at best to an eye clinic. On the way there, the eye should be rinsed continuously. The eye is then also rinsed at the ophthalmologist‘s, using medical solutions.
The ophthalmologist examines the eyes and assesses the extent of the damage. Any remaining chalk splinters are also removed. As an acute therapy, drops are given into the eyes at short intervals.
Primarily antibiotics, vitamin C drops and cortisone are administered. In the case of severe burns, eye drops are additionally administered to dilate the pupil. Vitamin C and cortisone are often additionally prescribed as tablets or infusions.
Irrigation is repeated at certain intervals. The doctor also determines how long the therapy must be continued. In science today, different flushing agents are discussed for their advantages and disadvantages.
A fundamental problem in the selection of the flushing agent is the question of what osmolarity it should have in comparison to the tear and chamber fluid. The problem with using normal water is that it contains fewer dissolved particles than the liquid inside the eye. The water diffuses to where there is a higher concentration of particles to compensate for the difference in concentration.
Thus, when water is applied to a damaged cornea as a rinsing agent, this water penetrates through the open areas of the cornea into the deeper areas of the eye and could increase a possible pre-existing accumulation of water (edema). This makes it easier for the corrosive chemical to penetrate further parts of the inner eye. Accordingly, a hypertonic (more dissolved parts) liquid is used in many places nowadays compared to the eye fluid. This prevents the water from penetrating through the damaged cornea. It is hoped that a flow of water and ions will be induced via the cornea out of the eye and the corrosive ions of the chemical will thus be dissolved out and not penetrate deeper.