A 28-year-old factory worker presents to triage immediately after a splash of household ammonia (an alkaline chemical) entered his right eye. What is the most appropriate immediate action?
Instill topical anesthetic drops, patch the eye, and irrigate only if pain persists after 15 minutes.
Begin copious ocular irrigation immediately, even before visual-acuity testing.
Delay irrigation until after a complete eye examination and initial pH testing are performed.
Place a rigid eye shield and await ophthalmology consultation before irrigating.
Alkaline substances rapidly saponify cell membranes and can penetrate ocular tissues within seconds, leading to severe, progressive damage. The first and most critical step-before visual-acuity testing or detailed examination-is to start copious irrigation with any available non-toxic fluid (e.g., saline, lactated Ringer solution, or even tap water) and continue until ocular pH normalizes. The same urgency applies to acid burns; both require immediate irrigation. Delaying irrigation for examination, pH testing, or specialist evaluation greatly increases the risk of permanent vision loss.
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Maxillofacial and Ocular Emergencies
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