ocular pain, foreign body sensation, red eye, tearing, photophobia, and blurred vision. Examination reveals decreased visual acuity and di use punctate lesions on fluorescein staining, with a sharp demarcation at the lower lid where the eye was protected. Treatment consists of cycloplegic drops, topical antibiotic ointment, and oral analgesics.

Prevention

Wearing protective eyewear often can prevent injuries to the globe. A study of patients in the US military who had sustained eye injury found that only a small percentage of them were wearing protective glasses at the time of injury [37,42]. In addition, many sports-related eye injuries could be prevented by wearing the recommended protective equipment. Air bag deployment, although associated with a 20% reduction in the incidence of fatal and severe injuries after frontal and near-frontal automobile collisions, increases the risk of orbital fractures or other ocular trauma [44].

Acknowledgment

The authors thank Dr. John Lee for his expert manuscript review and comments.

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Emerg Med Clin N Am

26 (2008) 125–136

Chemical, Thermal, and Biological

Ocular Exposures

Jordan Spector, MDa,b,

William G. Fernandez, MD, MPHa,*

aBoston Medical Center, Department of Emergency Medicine, Boston University School of Medicine, One BMC Place, Dowling 1 South, Boston, MA 02118, USA

bDepartment of Emergency Medicine, Albert Einstein Medical Center, 5501 Old York Road,

Philadelphia, PA, USA

Chemical or radiant energy injuries to the eyes are considered ocular burns. The majority of these injuries are occupation-related [1]. Chemical burns are by far more common and represent a true emergency. Thermal and UV injuries are associated with severe pain, but often result in less long-term sequelae than chemical injuries do. The term ‘‘biologic exposure’’ refers to an exposure to human blood or other body fluid. This article describes patterns of these injuries and exposures, with particular emphasis on emergent management and including acute diagnostic and treatment considerations.

Chemical burns

Chemical burns to the eye are common, particularly in industrial settings, and constitute an ocular emergency. In fact, chemical burns were the second leading cause of work-related eye injury treated in United States emergency departments in 1999 [2]. A burn may occur with exposure of the eye to any chemical, solid, liquid, or aerosol. Household cleaning supplies and cosmetics are common o enders. The potent alkaline or acidic substances contained within these products cause the burn injury. Accidents involving industrial materials in the workplace are a frequent cause of eye burns.

Chemical exposures to the eye can result in significant damage to the ocular surface epithelium, the cornea, and the anterior segment. Permanent unilateral or bilateral visual impairment may result. Alkaline substances can

* Corresponding author.

E-mail address: william.fernandez@bmc.org (W.G. Fernandez).