Overview
Triage the Exposure Before Touching the Eye
The first question is not “Which eye drop is ordered?” It is “What action prevents further loss of vision in the next minute?” A chemical injury continues while the substance re...
The first question is not “Which eye drop is ordered?” It is “What action prevents further loss of vision in the next minute?” A chemical injury continues while the substance remains on the ocular surface. Start irrigation immediately. Do not delay to obtain a complete history, measure visual acuity, contact the prescriber, or search for the product label. A structural injury is different: pressure, rubbing, manipulation, or removal of an embedded object can allow ocular contents to prolapse or worsen the wound. Protect the globe instead of examining it aggressively. Ask what happened, when it happened, and whether the substance was an acid, alkali, solvent, or particulate. Ask about high-velocity metal or glass, loss of vision, contact-lens use, anticoagulants, and prior eye surgery, but keep the questions brief when an emergency action is obvious. The patient’s own description—“something hit my eye and now I cannot see”—may be more urgent than the amount of external swelling. Use two immediate pathways: - Chemical on the eye: begin continuous surface irrigation and remove contact lenses if they come out easily during irrigation. -...