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 minute, 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