A 52 year old male presents to the ED with acute onset unilateral eye pain after an accidental splash into his eye while cleaning with an ammonia-based solution. He is noted to have a hazy cornea and faint blurring of the pupillary margin. What is the correct sequence of your ED management for this condition?

A. Test pH, irrigate until neutralized

B. Irrigate, test pH, irrigate until neutralized, check IOP

C. Check IOP, test pH, irrigate until neutralized

D. Obtain visual acuity, test pH, irrigate until neutralized

Answer: B. This patient has an ocular burn caused by an alkali substance. Alkali burns cause rapid liquefactive necrosis of tissues and are therefore more concerning than most acid exposures. For all chemical injuries of the eye, always irrigate first before all other interventions. Pause to check the pH but then resume for at least 30 minutes until pH neutralizes. Topical and oral analgesia should be offered to help the patient tolerate adequate irrigation via Morgan lens (a nasal cannula can also be placed over the bridge of the nose to irrigate both eyes if a Morgan lens is unavailable). When the irrigation process is complete, be sure to check IOP as secondary glaucoma is a known complication of ocular burns.

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