Chemical Eye Burns

Household cleaning products frequently cause chemical eye burns.

• Chemical exposure to any part of the eye or eyelid may result in a chemical eye burn. Chemical burns represent a small percentage of eye injuries.
• Some burns to the face involve at least one eye.
• Although many burns result in only minor discomfort, every chemical exposure or burn should be taken seriously. Permanent damage is possible and can be blinding and life-altering.
• The severity of a burn depends on what substance caused it, how long the substance had contact with the eye, and how the injury is treated. Damage is usually limited to the front segment of the eye, including:
  • the cornea, (the clear front surface of the eye responsible for good vision, which is most frequently affected),
  • the conjunctiva (the layer covering the white part of the eye), and
  • occasionally the internal eye structures of the eye, including the lens.
• Burns that penetrate deeper than the cornea is the most severe, often causing cataracts and glaucoma

Most chemical eye injuries occur at work. Industries use a variety of chemicals daily. However, chemical injuries also frequently occur at home from cleaning products or other regular household products; these injuries can be just as dangerous and must be treated seriously and immediately.

Chemical burns to the eye can be divided into three categories: alkali burns, acid burns, and irritants.

The acidity or alkalinity, called the pH, of a substance, is measured on a scale from 1-14, with 7 indicating a neutral substance. Substances with pH values less than 7 are acids, while numbers higher than 7 are alkaline; the higher or lower the number, the more acidic or basic a substance is and the more damage it can cause.

• Alkali burns are the most dangerous. Alkalis-chemicals that have a high pH-penetrate the surface of the eye and can cause severe injury to both the external structures like the cornea and the internal structures like the lens. In general, more damage occurs with higher pH chemicals.
  • Common alkali substances contain the hydroxides of ammonia, lye, potassium hydroxide, magnesium, and lime.
  • Substances you may have at home that contain these chemicals include fertilizers, cleaning products (ammonia), drain cleaners (lye), oven cleaners, and plaster or cement (lime). 
• Acid burns result from chemicals with a low pH and are usually less severe than alkali burns because they do not penetrate into the eye as readily as alkaline substances. The exception is a hydrofluoric acid burn, which is as dangerous as an alkali burn. Acids usually damage only the very front of the eye; however, they can cause serious damage to the cornea and also may result in blindness.
  • Common acids causing eye burns include sulfuric acid, sulfurous acid, hydrochloric acid, nitric acid, acetic acid, chromic acid, and hydrofluoric acid.
  • Substances you have at home that may contain these chemicals include glass polish (hydrofluoric acid), and vinegar. An automobile battery can explode and cause a sulfuric acid burn. This is one of the most common acidic burns of the eye. 
• Irritants are substances that have a neutral pH and tend to cause more discomfort to the eye than actual damage.
  • Most household detergents fall into this category.
  • Pepper spray is also an irritant. It can cause significant pain but usually does not affect vision and rarely causes any damage to the eye.

A true loss of vision signifies a very serious burn. Glaucoma, or an increase of the pressure inside the eye, can occur but may be delayed by hours to days.

Early signs and symptoms of a chemical eye burn are

• Pain
• Redness
• Irritation
• Tearing
• Inability to keep the eye open
• The sensation of something in the eye
• Swelling of the eyelids
• Blurred vision

For all chemical injuries, the first thing you should do is immediately irrigate the eye copiously. Ideally, specific eye irrigating solutions should be used for this, but if none are available regular tap water will do just fine.

• Begin washing your eye before taking any other action and continue for at least 10 minutes. The longer a chemical is in your eye, the more damage will occur. Diluting the substance and washing away any particles that may have been in the chemical is extremely important.
• Ideally, in a work setting, you would be placed in an emergency eyewash or shower station and your eye washed with sterile isotonic saline solution. If sterile saline is not available, use cold tap water.
• If you are at home and do not have a special eyewash, step into the shower with your clothes on to wash out your eye.
• Even though it may be uncomfortable, open your eyelids as wide as possible as you rinse them out.
• If an alkali or hydrofluoric acid burn has occurred, continue washing until a doctor arrives or you have been taken to a hospital's emergency department.

The next best step if possible is to find out what type of chemical you have been exposed to. You can look at the product label or call your regional Poison Control Center at (800) 222-1222 to find out more information about a specific chemical.

If the chemical is an irritant (with a neutral pH) and symptoms are only minor or nonexistent, then you may monitor your condition at home with a call to your ophthalmologist (a medical doctor who specializes in eye care and surgery). Make sure the burn does not worsen. If it does, call your ophthalmologist to arrange an appointment for that day or go to the emergency room if an Ophthalmologist is not available.

If you have any questions about the danger of a chemical, if you do not know what it is, or if you have significant symptoms, go immediately to the nearest hospital's emergency department.

Any time you experience pain, tearing, redness, irritation, or vision loss, go to a hospital's emergency department for immediate evaluation, even if you believe the chemical is only a mild irritant.

All acid or alkali eye burns require immediate treatment and evaluation by a doctor. You should be taken immediately to the closest emergency department. If you suspect a serious injury may have occurred or are otherwise not able to make the trip to the emergency room quickly, then you should call an ambulance to shorten transport time. All industries are required to keep a Materials Safety Data Sheet (MSDS) on any chemicals being used. Find this information and take it with you.

• Immediate therapy: Doctors likely will continue washing your eye. No standard exists for the amount of washing required. Usually, doctors use at least one liter of fluid.
  • Depending on the type of chemical involved, the doctor may test the pH of your eye and continue washing until the pH returns to normal.
  • You may receive topical anesthetic eye drops to numb your eye to make washing less painful.
  • Doctors will wipe or irrigate away any solid foreign material in your eye.
• Exams and Tests: The doctor determines what chemical caused the burn and completes a thorough eye examination.
  • You are given an eye examination using an eye chart to determine how well you can see.
  • Structures surrounding the eye are checked.
  • Eyelids, in particular, require careful assessment. The doctor turns them inside out to look for foreign material.
  • The doctor may stain your eye with a dye called fluorescein to help determine the extent of the damage.
• If the burns are minor, you are usually sent home with antibiotic eye drops and oral pain medications. Occasionally, you may be given dilating eyedrops to help with comfort, and your injured eye may be covered with an eye patch.
• Any significant burn, especially an alkali or hydrofluoric acid burn, may require admission to the hospital.
• For any minor injuries, an ophthalmologist should evaluate you within 24-48 hours of your injury. For any moderate to significant injury, an ophthalmologist should evaluate you before you leave the Emergency Room.
• Your tetanus immunization status may be determined and updated.

• For very minor injuries, you may need nothing more than artificial tears or lubricants for dry eyes.
• For more significant injuries, you will need prolonged therapy with potentially many medications to heal your eye.
  • Until the surface of the eye heals, it is at a higher risk for infection; therefore, topical antibiotics may be used in the form of eye drops or ointments.
  • Topical steroids are used to reduce inflammation and to facilitate healing early in the recovery period after a chemical injury. These medications should be used judiciously under the guidance of an ophthalmologist, because they can cause long-term complications, such as infections and glaucoma.
  • Other medications used to support corneal repair include topical citrate and ascorbate drops, oral antibiotics (for example, tetracycline, doxycycline), and oral vitamin C.
  • If your eye pressure is too high, glaucoma medications may be used temporarily to control the pressure.
  • Pain medications by mouth may be necessary, and dilating eyedrops are often also used to control pain and to aid recovery.
• If your eye has been seriously damaged, you may need surgery to control glaucoma, remove a cataract, or other procedures to restore a healthy ocular surface and eyelids.

• Surgical measures may be necessary after severe chemical injuries when the initial injury has healed.
  • Chemical injuries may necessitate surgery to the eyelids to restore good eyelid closure to protect the eye.
  • If the surface of the eye is severely damaged, a specialized set of cells called Limbal stem cells may be damaged and require replacement to prevent surface scarring.
  • If the cornea becomes opaque (or cloudy) following a chemical injury, a corneal transplant may be required.
  • Chemical injuries, especially from alkaline substances, can also cause cataracts and glaucoma, which may also require later surgical intervention.

If you are treated for a chemical burn to the eye in a hospital's emergency department, you should see an ophthalmologist within 24 hours. The ophthalmologist determines your continuing care.

Safety officials estimate that most chemical eye injuries can be avoided.

• Always wear safety glasses when working with hazardous materials, both at work and at home.
• Children sustain chemical burns most often when they are unsupervised. Keep all hazardous home products away from children.

Recovery depends on the type and extent of the injury. Every exposure to foreign substances or “chemicals” does not necessarily result in injury.

• Chemical irritants seldom cause permanent damage.
• Recovery from acid and alkali burns depends on the depth of the injury.

The 4 grades of burns are

• Grade 1: You should recover fully.
• Grade 2: You may have some scarring, but your vision should recover.
• Grade 3: Your vision will usually be impaired to some degree.
• Grade 4: Damage to your vision likely will be severe.

1. Is there any sign of significant damage to the eye?
2. What medications am I to take, and for how long?
3. When am I supposed to visit the doctor for a follow-up again?
4. Is there any chance of permanent vision loss?