Household bleach is a common cleaning agent containing sodium hypochlorite, typically in a solution of 3% to 8% concentration. Bleach is highly corrosive to the delicate tissues of the eye, meaning exposure is an ocular emergency that can cause blindness. Immediate action is required to prevent permanent vision loss. The severity of the injury depends on the concentration of the bleach, the duration of contact, and the speed of the initial first aid response.
The Mechanism of Chemical Burn Injury
The reason bleach is so damaging to the eye is its high alkalinity, measured as a high pH level, often around 11 to 13 for household varieties. When bleach contacts the eye, the alkaline substance rapidly penetrates the tissue layers in a destructive process known as liquefactive necrosis. This differs significantly from an acid burn, which typically causes coagulation necrosis, where proteins solidify and create a protective barrier that limits deeper damage.
The hydroxyl ions in the bleach solution react with the fatty acids in the cell membranes of the eye, a process called saponification. This chemical process allows the bleach to quickly move through the cornea and into the deeper internal structures. Potent alkali agents can reach the anterior chamber of the eye in as little as 5 to 15 minutes, causing damage to the lens, iris, and ciliary body. This progressive destruction means the chemical is actively causing harm long after the initial splash, making immediate removal of the agent the most important factor in saving vision.
Immediate Emergency First Aid Procedures
The most consequential action following bleach exposure is the immediate and copious irrigation (flushing) of the eye with water or saline solution. Damage begins within minutes, so flushing must start within seconds of the exposure. Use any available non-caustic fluid, such as tap water, as the priority is dilution and removal of the corrosive chemical.
The injured eye must be flushed continuously for 15 to 30 minutes to ensure the caustic agent is thoroughly washed out. This requires holding the eyelids open and directing a gentle stream of water over the surface of the eye, ensuring the water flows away from the other eye. If contact lenses are worn, remove them immediately during flushing, as they can trap the bleach against the eye’s surface and worsen the chemical burn. While flushing, arrange for emergency transport or call emergency services (such as 911 or Poison Control), but do not delay irrigation to travel.
Hospital Treatment and Long-Term Visual Recovery
Upon arrival at a medical facility, professional care focuses on neutralizing the chemical environment and assessing tissue damage. Clinicians continue the irrigation process until the eye’s surface pH returns to a normal, non-alkaline range (typically between 7.0 and 7.2). The ocular pH is checked regularly to confirm the corrosive chemical has been completely removed from the eye’s surface.
The eye injury is classified using a grading system, which helps predict the long-term prognosis based on the clarity of the cornea and the degree of damage to the limbus. Treatment for severe burns includes topical antibiotics to prevent infection, medications to control intraocular pressure, and anti-inflammatory topical steroids to manage the intense inflammation. In the most severe cases, where initial damage has caused extensive death of the limbal stem cells, recovery may require complex surgical interventions. These procedures include corneal transplantation or limbal stem cell transplantation to help restore a healthy surface to the eye. The potential for permanent visual impairment or blindness is directly correlated with the initial severity of the burn.