Peds EM Pearl: treatment of ocular chemical exposure

By Elizabeth Thorpe, MD
Pediatric Emergency Medicine Residency Attending

A 3 yo male presents to the ED after a cascade liquid dishwashing packet burst while he was playing with it and splattered into his left eye.    His pupil is reactive and his extra–ocular movements are intact.   He has significant injection of the left eye but no signs of trauma.

The next best step is:

1. Immediate eye irrigation with Morgan lens for 5 minutes to limit damage to eye
2. Eye irrigation under procedural sedation
3. Eye irrigation only after initial eye pH obtained
4. Immediate eye irrigation with Morgan lens for 20 minutes
5. Ophthalmology consultation

ANSWER:

• Immediate irrigation with Morgan lens for at least 20 minutes is critical in this patient who has a chemical chemosis.  While procedural sedation is nice for the active child, it is not usually necessary, especially if tetracaine is used.  A papoose board will most likely be necessary but the undesirability of physical restraint is outweighed by the necessity of immediate irrigation to prevent more eye damage.  Obtaining an initial pH is helpful but not necessary.  At least 20 minutes (one liter of saline is an nice guide for a child) of irrigation should be performed.   Irrigation should never be delayed for specialty consultation.
  

PEARL

Immediate irrigation with Morgan Lens is essential for pediatric eye exposures

If you have never used a Morgan Lens go to this site for instructions:

http://www.morganlens.com/use.html

Or watch the following youtube video available from MorTan, Inc. at:

http://www.morganlens.com/video.html