Household bleach, a common cleaning product, contains sodium hypochlorite and is classified as an alkaline substance with a high pH, typically around 12. This high alkalinity makes it highly corrosive to the delicate tissues of the eye. Unlike acidic substances that often cause immediate, superficial damage, alkaline chemicals penetrate the ocular tissue quickly and deeply. This rapid penetration can cause a process called liquefaction necrosis, leading to severe and progressive tissue destruction. The speed of this chemical reaction necessitates immediate, aggressive action to prevent lasting injury.
Immediate Priority: Continuous Eye Flushing
The most important step upon exposure is to begin continuous irrigation of the affected eye immediately, before attempting to call for help or transport. Do not delay this first aid measure for any reason, as every second the bleach remains in contact with the eye tissue increases the risk of permanent damage. Diluting the chemical is the only way to halt the corrosive process and begin to neutralize the high pH of the substance.
Flushing should be maintained for a minimum of 15 to 20 minutes, or up to 30 minutes if the child is cooperative. Use clean, lukewarm running tap water, or a sterile saline solution if immediately available. Positioning the child correctly ensures the contaminated water does not flow into the unaffected eye.
Have the child tilt their head over a sink so the affected eye is lower than the unaffected one. The water stream should be gentle, directed at the inner corner of the eye (near the nose), allowing it to flow across the eye surface and drain out the outer corner. It is important to hold the eyelid open as wide as possible during the entire flushing period, which can be difficult due to pain and involuntary spasm. Encourage the child to move their eye in all directions to ensure the water reaches all surfaces, including under the eyelids.
The constant flow of water washes away the sodium hypochlorite and works to restore the eye’s neutral pH level. If the child is small, wrapping them in a towel (the “mummy wrap”) can help keep their arms still for more effective irrigation. A gentle stream from a showerhead or a pitcher poured steadily over the eye can also be an effective technique.
Essential Next Steps: Contacting Emergency Services
Once the 15-to-20-minute irrigation period is complete, immediately contact emergency medical services or the Poison Control Center for further guidance. The Poison Help Line, reachable at 1-800-222-1222, is staffed 24/7 by experts who can provide specific instructions based on the details of the exposure. Calling immediately after irrigation ensures professional advice is received without delaying the first-aid step.
Be prepared to relay specific details to the specialist or dispatcher. This includes the substance (bleach), its concentration, the duration of exposure before flushing, and the symptoms the child is experiencing. Symptoms to report include persistent pain, redness, swelling, excessive tearing, or any visual changes.
If severe symptoms like a seizure, collapse, or difficulty breathing occur, immediately call 911. The child will need transport to an emergency room for assessment. During transport, continue flushing the eye with a mild stream of water, such as saline, if the child tolerates it. Bring the bleach container to the hospital so medical staff can confirm the chemical components and concentration.
Medical Assessment and Follow-up Care
Upon arrival, the medical team’s priority is to ensure the eye surface pH has returned to a neutral level. This is typically done using pH-sensitive paper, a test that confirms the success of the initial irrigation. If the pH is still elevated, the medical team will continue with copious irrigation, often administering a topical anesthetic to manage the pain and allow the child to keep the eye open.
Following neutralization, a comprehensive ophthalmologic examination is necessary, usually involving a slit-lamp microscope to assess damage. The examination determines if the cornea (the clear front surface) or the conjunctiva (the membrane covering the white of the eye) has been affected. Potential treatments may include topical antibiotic drops to prevent infection and pain medication for comfort.
In cases of more severe burns, the child may be prescribed topical steroids to manage inflammation or cycloplegic drops to relax the eye muscles and reduce pain. The prognosis is linked to two factors: the concentration of sodium hypochlorite and the speed and duration of the initial flushing. Long-term follow-up with an ophthalmologist is standard, as severe burns can lead to potential complications like corneal scarring, chronic dry eye, and permanent vision impairment.