A chemical exposure to the eye is an emergency that demands immediate action to prevent permanent damage. The primary goal of flushing is to dilute the chemical and mechanically wash it away from sensitive tissues. Damage can begin within seconds, making rapid, thorough irrigation the single most important first aid step. Delaying treatment can lead to serious and lasting injury.
Immediate Steps for Eye Flushing
The first step is to quickly find the nearest source of clean, lukewarm water or sterile saline solution. Lukewarm water, ideally between 60 and 100 degrees Fahrenheit, is preferred because extreme temperatures can either facilitate chemical reactions or cause discomfort, leading to the flushing process being cut short. Begin flushing immediately, using a shower, hose, or running faucet if necessary, before spending time removing clothing or seeking a specific eyewash station.
It is essential to hold the eyelids open with your fingers to ensure the water reaches all parts of the eye, particularly under the lids where chemicals or solid particles can become trapped. The water stream should be gentle, not forceful, and directed so it flows from the inner corner of the eye (near the nose) outward. Tilting the head so the affected eye is down and to the side prevents the chemical from washing into the unaffected eye.
If contact lenses are worn, remove them immediately, but do not delay the start of flushing. If the lenses do not come out easily, continue irrigation, as the water pressure may dislodge them. Ensure the water is running continuously, using a large supply, to effectively dilute and remove the chemical from the corneal and conjunctival surfaces.
Determining the Necessary Flushing Duration
The time required to flush the eye depends significantly on the type of chemical involved. For most irritants or chemicals where the nature is unknown, the standard minimum recommendation is to flush continuously for at least 15 minutes. This minimum timeframe aligns with the duration required for emergency eyewash stations to supply water.
However, the most severe injuries are caused by highly corrosive substances, which require substantially longer flushing times. Chemical burns are categorized based on their pH: acids have a low pH and alkalis (bases) have a high pH. Acids, such as those found in car batteries, often cause protein coagulation on the surface of the eye, which can create a barrier that limits deeper penetration. For strong acids, flushing for 15 to 20 minutes is recommended.
Alkaline chemicals, including drain cleaners, ammonia, and lye, are far more dangerous because they cause liquefaction necrosis, allowing them to penetrate ocular tissues more deeply and rapidly. Alkaline burns require a much longer flushing duration, often 30 minutes or more, with some guidelines recommending up to 60 minutes for these penetrating corrosives. Flushing should ideally continue during transport to a medical facility until the eye’s pH returns to a neutral level.
Post-Flushing Medical Protocol
After the required sustained flushing period is complete, seeking professional medical attention is mandatory, regardless of how minor the injury may appear. Even if the eye feels better, the severity of a chemical burn cannot be judged solely by the degree of pain, as some serious alkaline burns may initially be less painful. An ophthalmologist or emergency physician will perform a full eye examination and may continue irrigation to confirm the chemical has been completely removed.
When preparing for transport, it is crucial to bring the container of the chemical that caused the injury, or at least the name of the substance. This information allows medical staff to understand the chemical’s properties and tailor the necessary treatment plan. If vision is impaired, arrange for someone else to drive, as impaired vision makes operating a vehicle unsafe.
During transport, avoid rubbing the eye, as this can cause further mechanical damage and push chemicals deeper into the tissue. Do not attempt to bandage or cover the eye with pressure, but wearing dark glasses may help reduce light sensitivity if the eye is painful. The medical team will use specialized tools, such as pH strips, to check the eye’s surface and confirm that the prolonged flushing successfully neutralized the chemical residue.