Chemical splashes can arise from liquid or spray chemicals:
Liquid chemical splashes
The recommended treatment for liquid chemical splashes to the eye is prompt irrigation with copious amounts of water or normal saline [35].
The earlier that initial irrigation of the eye begins has been shown to have the greatest influence on the prognosis and outcome of chemical burns [36].
There is no good data to support the role of water as the most appropriate irrigation fluid for the management of chemical burns to the eye, and current expert consensus is that normal saline should be used for eye irrigation following chemical splashes and burns [37-38].
Litmus paper should be used to judge the response to irrigation, which can be stopped when the pH returns to neutral (pH 7.0-7.3) [39].
Following irrigation, the eye(s) should be stained with fluorescein. If fluorescein uptake is demonstrated, referral to an ophthalmologist is recommended although local policy should be followed.
Chemical spray
CS spray (o-chlorobenzylidene malonitrate) is largely in use by police forces as a chemical incapacitant spray. In its aerosol form, CS is dispersed as a fine dust and produces side-effects including ocular symptoms such as lacrimation, blepharospasm, erythema of the conjunctiva and periorbital oedema occur.
Irrigation can worsen the symptoms as CS is highly soluble in water.
Expert opinion suggests that the best way to manage corneal injuries resulting from CS spray is to place the patient in a well ventilated area and use a fan to blow air directly across the eyes, ensuring no cross-contamination occurs with others in the vicinity [40]. The image shows a fan blowing air across the eyes.
Learning bite
Eyes should be irrigated copiously after chemical splashes until the pH returns to neutral. In CS spray injuries, eye irrigation will worsen symptoms and should not be used.