A 35-year-old laboratory technician presents to the ED with a bilateral ocular chemical injury from an unknown substance. Initial pH testing reveals an ocular surface pH of 10. Visual acuity is significantly decreased in both eyes. After copious irrigation, which of the following interventions is most appropriate for this specific type of chemical burn?
Administer autologous serum drops and topical steroid eye drops
Continue irrigation with normal saline and administer topical ascorbic acid (vitamin C) drops
Irrigate with an amphoteric solution and apply a bandage contact lens
Apply topical acetylcysteine and begin oral prednisone therapy
The correct answer is to continue irrigation with normal saline and administer topical ascorbic acid (vitamin C) drops. The pH of 10 indicates an alkali burn, which is generally more severe than acid burns due to their ability to penetrate deeper into ocular tissues.
Alkali burns require prolonged irrigation, often for several hours, to ensure complete removal of the chemical. Topical ascorbic acid is specifically beneficial in alkali burns as it helps to neutralize the alkali and reduces collagen breakdown in the cornea.
While acetylcysteine is useful in some ocular conditions, it's not the primary treatment for alkali burns. Amphoteric solutions are more beneficial for acid burns. Autologous serum drops can be helpful in severe cases but are not the immediate treatment of choice. Steroids may be used later in treatment but are contraindicated in the acute phase as they can increase the risk of corneal melting.
Understanding the specific management of different types of chemical burns is crucial for optimal patient outcomes in emergency settings.
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Maxillofacial and Ocular Emergencies
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