9.6  Which Care Chain for Optimum Management of Chemical Eye Burns?

For the irritating or corrosive chemicals we are concerned with here, the top priority is to break the “product– human tissue” contact. This can be done in two ways:

•Through spontaneous mechanical entrainment by the victim or by the witnesses: wiping, washing with copious amounts of water

•By fully neutralizing the product by chemical means (“antidote effect”)

9.5.3  The Specific Management

of Chemical Injuries

Any attempt to administer care after an accident or chemical aggression is doomed to failure if it is impossible to “remove” the aggressive product (or move away from it).

On the other hand, any procedure and any “neutralizer” that prevents or effectively reduces the time of contact with the eye as soon as the chemical nature of the aggression is recognized will be beneficial.

Therefore, it is obvious that, to apply these principles and use this “neutralizer” as soon as possible, the emergency procedure should be well known to everyone and sufficiently simple. In addition, to avoid any loss of time, the “neutralizer” should always be available near the risk.

Once the aggressive product is “neutralized,” in the broad sense of the term, than medical care can begin. In all cases of chemical eye injury, medical advice should be sought as soon as possible.

eye burns is “either it is not serious and it will heal, or it is very serious, and there is nothing we can do.” Now, it is the ophthalmologist’s expertise which will dictate the course of action to be taken. This biased assessment of the problem led to the implementation of treatment strategies, which are interesting but have limitations.

9.6.1  Immediate Care by “Nonspecialists”

First limitation: immediate care is administered to the victim by nonspecialists, or even non-healthcare people. Now, there has been one dogma in France for several decades: a chemical eye burn means washing with water and, above all, not using anything else, especially no “neutralizing” solutions.

This course of action has unquestionable clinical and experimental arguments but only when action is taken during the very first seconds after the corrosive chemical splash. Water rinsing has only a mechanical action, entraining the chemical out of the eye. Therefore, it will simply reduce the number of potential chemical aggressors on ocular tissue.

After one minute, however, all the experimental studies have demonstrated the ineffectiveness and even harmfulness of eye rinsing with water or with the other isotonic solutes (isotonic to blood). In fact, these aqueous solutions dilute the chemical substance and facilitate the release of the active ions of the corrosive or irritating product. In addition, being hypoosmolar to the cornea, aqueous solutions create flows from tissue surface to the inside, favoring the penetration of the chemical into ocular tissue (see Chaps. 5 “Physiopathology” and 6 “Eye Rinsing Solutions”).

9.6  Which Care Chain for Optimum Management of Chemical

Eye Burns?

The management of chemical eye burns is not the sole concern of the ophthalmologist. It takes often several hours between the burn and the visit to the ophthalmologist. During this time, many treatments have been administered, or most often, not administered because they have not been approved by the specialist. Therefore, at the time of the visit to the ophthalmologist, the prognosis is already settled. Here, we have a vicious circle: the most common vision ophthalmologists have of chemical

9.6.2  Ophthalmological Management

is Often Deferred

This is the second limitation of common treatment strategies. For specialist care to victims of chemical eye injuries, ophthalmologists, especially French ophthalmologists, have developed since quite a long time more or less complex surgical strategies to attend to restore sight to severely burnt people: corneal grafting, limbal autograft or allograft, amniotic membrane grafting, and keratoprosthesis.

9.6.3  Practical Consequences

for More Effective Management

In addition to these specialist treatments that are relatively late with the reference to the initial chemical splash, there remains ample room for another treatment objective aimed at avoiding or limiting the immediate seriousness of a chemical eye.

To achieve this aim, you need a real eye burn management chain. In reality, many persons will give aid to the burnt person before he/she meets the ophthalmologist. Therefore, the setting up of an eye burn care chain is possible. The difficulty will be to have persons who are most often unqualified administer initial care. This is possible, on the basis of our experience, under three conditions: a good protocol, suitable training, and technical supervision by healthcare professionals.

9.6.3.1  Develop a Protocol Which Must Be Simple in Every Aspect

•Understandable in view of the desired therapeutic action, in order to gain acceptance by the person who is to use it

•Easy to implement, by simple decision-making because of the absence of any contraindication and side effect

•Easy and very quick to implement

9.6.3.2  Training

Training will be essential for the persons who are to implement the protocol. This training shall be given initially and regularly updated. It will combine theoretical aspects and especially practical situations consistent with the type of risk.

9.6.3.3  Necessary Specialized Supervision

This is the third and last condition to achieve a credible, effective system. The action should be supervised by recognized healthcare professionals, so that it is professionally credible and follow-up can be ensured to take account of the results and improve the relevance and quality of the implemented system.