Irritant/chemical conjunctivitis results from exposure of the conjunctiva to toxic agents that results in chemosis, edema, and hyperemia. These findings can be very similar to allergic conjunctivitis; therefore, history of exposure to an offending agent is helpful in making the diagnosis. Common exposures are smoke from fires, swimming pool chlorine, household chemicals, and cosmetics.
Chemical Conjunctivitis. Typical exposure pattern conjunctivitis (upper conjunctiva spared) after laundry detergent exposure. (Photo contributor: Kevin J. Knoop, MD, MS.)
Patients will typically present with burning in the eyes. A mucous discharge may also be present with a papillary reaction of the palpebral conjunctiva. Eyelid findings may also be present with swelling, thickening, or excoriation marks due to resultant itching. Typical cases will demonstrate punctate epithelial staining with fluorescein application.
Management and Disposition
Immediately after an irritant exposure, initiate eye irrigation to remove any remaining chemical. Patients should immediately stop use of any cosmetics or topical medications that may be the source of irritation. Most cases can be treated with cold compresses, artificial tears, or lubricating eye drops or ointments to soothe ocular irritation. Most cases resolve with expectant management.
Nasal cannula tubing can be connected to a bag of normal saline to irrigate chemical ocular exposures when a formal eye wash is not available. The nasal cannula prongs will direct flow directly into each eye.
A thorough history considering offending agents that are used with chronicity may lead to the diagnosis in patients in whom no obvious chemical irritant is identified.
Chemical Conjunctivitis. Patient with bilateral chemical conjunctivitis after tree sap exposure to both eyes. Bilateral pterygia are also seen. (Photo contributor: Denise Whitfield, MD, MBA.)