CHEMICAL EXPOSURE TO THE EYE

Effective Date: 
Wed, 09/02/2015
Policy: 

To appropriately expedite the care of patients with chemical exposures to eyes in order to minimize potential for related vision loss.

Procedure: 

1.  Patient calls or presents with history of chemical exposure to one or both eyes

2.  Staff member receiving this information informs the Charge Nurse in person or by phone.  During lunch, notify Same Day Clinic Nurse

3.  Charge Nurse:

  • Delegates nurse to begin eye irrigation with Lactated Ringers solution via the Morgan Lens.  Ophthalmic anesthesia eye drops may be used if needed to perform irrigation.  If only one eye is affected, be sure irrigation solution drains away from the unaffected eye. Contact lenses if in place should be removed immediately
  • Identifies a clinician who is immediately available to evaluate the patient
  • Delegates another staff member to find the Safety Data Sheet (SDS) of the chemical, print the SDS, and give it to  the treating clinician.  The quickest way to find an SDS may be to "google" it

4.  As soon as ophthalmic pH paper is available, check pH of both eyes (affected and unaffected) as a baseline and documented in the EMR.  Irrigation is continued until the pH of the affected eye is between 7.0 and 7.2.

5.  Documentation of the following is needed:

  • Time of exposure
  • Duration of exposure
  • Any flushing of the eye done prior to presentation at the SHC, including the type of fluid and length of irrigation
  • Accurate information about the chemical involved, especially the pH.  The SDS of the product should be referenced as soon as possible

6.  When the pH of the affected eye(s) is between 7.0 and 7.2, the clinician should perform a full ophthalmic exam, including:

  • Eversion of eyelids with sweep of fornices with wet cotton swab to detect and remove any particles
  • Fluorescence exam of cornea and conjunctival epithelium
  • Examination of unaffected eye, including pH, to assure that both eyes are not involved
  • Visual acuity including "pinhole" testing for patients who need correction     

7.  Clinician or their designee may consult poison control and/or ophthalmologist on-call for clinical guidance as appropriate to the situation.  UCSC Optometrist may be involved as needed, if on site.  If the patient needs transport to the hospital before pH is corrected, irrigation should continue during transport

 

Key Points: 
  • Irrigation of the eye with exposure to chemical should not be delayed for anything
  • SDS of the chemical involved should be accessed as soon as possible
  • Contact lenses if in place should be removed immediately