3.1 Chemical Injury, Conjunctival

eyes.nhs.scot/
Eyecare Guidelines/
Section 3 - Conjunctiva/
3.1 Chemical Injury, Conjunctival

Date of last review: Due to be updated

Differential diagnosis

Corneal abrasion
Other causes of acute red eye; history should aid the diagnosis

Possible management by Optometrist

Treatment

Copious prolonged irrigation of the eyes with sterile normal saline or, if not immediately available, tap water
Irrigate for 30 minutes (with intermittent topical anaesthetic if required) or until pH between 7 and 8

To measure, cease irrigation, wait for 1 min, apply universal indicator paper to fornix
When pH normal stop irrigation and re-check after additional 30 minutes

Remove any particulate matter
Give ocular lubricants for symptomatic relief

Manage as abrasion if epithelial loss

Ask if allergic to Chloramphenicol
If not, supply Chloramphenicol 1% eye ointment 3 times daily for 5 days
If allergic to Chloramphenicol, or pregnant, supply Fusidic acid 1% liquid gel twice a day for 5 days

For pain or photophobia, advise systemic analgesia and darkened room

Advice

Contact lens solution accidents do not require irrigation, but advise no contact lens wear until after satisfactory review

Management Category

Severe cases require immediate referral

Any strong alkali or acid burn
Limbal ischaemia
Loss of corneal transparency

Mild cases: normally no referral

Possible management by Ophthalmologist

Further irrigation
Admission to hospital where necessary
Topical and oral treatment
Surgical rehabilitation

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