Ocular burns are true emergencies and represent a up to 10% of ocular trauma cases.1,2 Chemical burns account for the large majority of ocular burns with thermal burns being the second most common cause.3 Most victims are young males.2,4,5 The industrial workplace is the most common setting, although a significant number of cases occur in the home.4 Assaults are a significant cause of ocular burns in the lower socioeconomic groups of large cities.4,6
Caustic agents are primarily responsible for the most severe chemical ocular burns. Most reports indicate that alkali burns are more frequent than acid burns.1,3,4,7 Examples of more common alkalis and acids are listed in Table 187-1.4,8-15 Ammonia causes the most serious alkali burns.4 Calcium hydroxide (i.e., lime) is the most common cause of alkali burns.4 Hydrofluoric acid causes the most serious acid burns.4 Sulfuric acid is the most common cause of acid burns.4 Caustic agents account for only a minority of chemical ocular exposures.1 Most chemical ocular exposures are due to relatively innocuous noncaustic substances (e.g., shampoos, hair sprays, and personal defense sprays) and therefore do not cause significant or lasting damage.1,16-21
TABLE 187-1Common Caustic Agents and Their Sources ||Download (.pdf) TABLE 187-1Common Caustic Agents and Their Sources
|Substance ||Class ||pH ||Source |
|Ammonium hydroxide ||Alkali ||11.6 ||Fertilizers, refrigerants, sparklers |
|Calcium hydroxide ||Alkali ||12.4 ||Mortar, plaster, cement |
|Magnesium hydroxide ||Alkali ||10.0 ||Sparklers, fireworks |
|Potassium hydroxide ||Alkali ||11.0 ||Oven and drain cleaners |
|Sodium hydroxide ||Alkali ||14.0 ||Lye soaps, airbags, EMLA cream, hair straightener |
|Sodium hypochlorite ||Alkali ||11.0 ||Bleaches, drain cleaners |
|Acetic acid ||Acid ||2.9 ||High vinegar concentrations |
|Chromic acid ||Acid ||3.0 ||Chrome plating |
|Hydrochloric acid ||Acid ||1.1 ||Household and pool cleaners |
|Hydrofluoric acid ||Acid ||2.1 ||Rust removers, glass, mineral, gasoline, silicone industries |
|Sulfuric acid ||Acid ||1.2 ||Industrial cleaners, battery acid |
|Sulfurous acid ||Acid ||1.5 ||Bleach, refrigerants |
Ocular irrigation is a simple procedure that is commonly employed in the Emergency Department.22 It is potentially an eye-saving procedure in the setting of significant chemical ocular burns. Physicians, nurses, and emergency medical personnel who deal with ocular emergencies should be trained in ocular irrigation. First aid personnel in the workplace should be familiar with the use of ocular irrigation.23 Ocular irrigation must be employed rapidly.1,22,24,25 Delays in irrigation can limit its effectiveness and increase morbidity.3 A treatment algorithm is shown in Figure 187-1.
An algorithm for the Emergency Department management of ocular exposures.
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