Published in "Panorama"
CHEMICAL EYE INJURIES – SOME SIGHT-SAVING TIPS
It can happen in the blink of an eye. While pouring liquid drain cleaner down a sink, some of the chemical may splash on the face and hit one squarely in the eye. It is possible that one could get a few whiffs of spray in the eyes when spraying his or her morning perfume or while using aerosol air fresheners.
Disinfectants, soaps, detergents, oven and window cleaners, cosmetics, solvents, and a whole host of common household products could cause damage to the eyes if their users are a trifle careless! Burns to the eyes from thermal or heat injuries can also happen when people are exposed to steam, hot smoke or gases, hot liquids, molten metal, fires and cigarette burns.
Chemical injuries to the eyes is an emergency and it need not happen only in the workplace! Practically every home has several common household products of daily use which could cause irreversible damage to the eyes if not handled with care, in as little as five minutes or even less, reveals Dr.Azim Siraj, Specialist Ophthalmologist, Jumeirah Prime Medical Centre, Dubai.
Emphasizing the need to exercise care, Dr.Azim explains, “The eye is one of the most delicate organs in the human body and when it is subject to an injury, not detected and treated on time, no matter what you do and how much you spend, it may be extremely difficult to get back the normal anatomical architecture and physiological function back to the eyes! The structures in the eye are so delicate and finely layered one on top of the other, that once insulted, it is like a boiled egg which cannot be brought back to its raw form; it undergoes certain changes and it is unlikely to get back to its normal shape.”
Injury to the eye caused by burns from strong acids or alkalis are amongst the most urgent of ophthalmic emergencies, which if left unattended or treated improperly, can threaten vision. The damage caused by any chemical injury depends largely on the concentration and pH (acidity) of the causative agent duration of exposure and the outcome depends on the promptness and completeness of care given. contrary to what people at large may believe, injury to the eye due to alkalis are more severe and more damaging in their effect, than acid burns!
This is because, alkalis have the ability to penetrate tissues rapidly unlike acid burns which largely confine to the ocular surface. Dr.Azim explains, “As soon as acid touches the body, it forms a precipitate as when milk curdles on squeezing lime into it. This forms a barrier for the acid to penetrate further. Alkali on the other hand, melts into the tissues, dissolving all the membranes. Here, I would say, ammonia is the most dangerous. Besides being deeper and penetrative, alkali burns can cause more long term effects than acid burns.”
When chemical falls on the naturally transparent cornea, depending on the extent of the injury and the specific chemical, it can become opaque. This could lead to the whole vision getting blocked or getting weakened or it can form holes, which is a very dangerous situation. The most common, household alkaline substances include drain cleaners, ammonia, automatic dishwashing detergents and oven cleaners.
Other common sources of accidental chemical spills which could injure the eyes include paints used for white washing the house and liquid in the Car batteries which can spill on to the eyes when one attempts to jump start the car without taking adequate care to keep the face away from it.
Symptoms following chemical injury to the eye include pain, foreign body sensation, redness of the eye and eyelid surface, burning sensation, excessive watering and blurred vision headaches, and sometimes, in severe cases, vomiting. How long symptoms last depends on the type of chemical and the amount that has gotten into the eye. Accident victims with burn injuries to their eyes may have swollen eyes, complain of a foreign-body sensation, pain, excessive watering and impaired vision.
Often, the difference between a salvaging and losing vision, is a matter of understanding a few important tips for ocular first aid, emphasizes Dr.Azim. When there is heat as from fire falling in, first step is to wash with clean water, preferably with drinking (not tap) water. Because of fire, there can be soot and other carbon-related compounds which can get stuck in the eye. Take a bucket of water and blink inside it, rolling the eyeball. This is the mainstay of treatment when exposed to dry heat.
• Don’t try home remedies like putting milk or other solutions.
• Don’t put any eye drop that may be there at home.
• However, it is always advisable to have a new bottle of antibiotic(non steroidal combination) eye drops at home for use in such emergencies. But these should have been prescribed by a doctor, keeping in view any allergies, systemic illnesses that may be associated.
• In the event of an eye injury, put one drop of the antibiotic every 5 minutes, twice or thrice, after completely washing the eye. These drops will protect the eye from any secondary infection
• Do not rub the eye or squeeze the eyeball.
• Do not use old, open bottles of antibiotic drops.
• Don’t try to examine the eye and see what’s happened
• Take a clean kerchief or pad to gently cover the eye and then go to the doctor at the earliest.
• If there is some swelling, you can use gentle cold compress.
In the event of chemical injuries, in addition to the above measures, adhere to the following also:
1. Immediately shift the victim from the scene of the incident to a well aerated place and remove any contaminated clothing.
2. It is very important to immediately wash the eye with copious amounts of running water. There is no point taking a cup or bucket of water and rolling the eye inside it.
3. Continued flushing of the eye should be done for a minimum of 30 minutes.
4. Tap water here ( Desalinated, chlorinated water) itself contains a few chemicals. So it is ideal to use bottled drinking water, if adequately available.
5. It is important to gently hold the lids apart while irrigating in order to rinse underneath the lids and wash away as much of the chemical as possible.
6. If only one eye is affected by the chemical, turn the face towards the involved eye so that the water will run down, thereby avoiding any accidental spillage of the contaminated water on to the other eye.
7. If available, 2-3 drops of an antibiotic (non steroidal) eye drops (taking the precautions mentioned in on of the earlier paragraphs) may be instilled every 5 minutes in both eyes and the victim should keep eyes closed and rush to the nearest medical center.
No matter the nature of the burn, even if the victim feels better after washing the eye, he or she must see a doctor immediately because it can be a temporary subsidence of the problem! Also it should be remembered that eye injuries may be associated with more serious life threatening involvement of other organs and hence the victim should be rushed to the nearest medical center for professional care.
A doctor (preferably an ophthalmologist) should evaluate every chemical eye injury. The treatment usually starts with irrigation of the eye using a sterile solution, till such time that the pH is normal or near normal. The specialist would then remove any foreign particles that may be lodged in the eye. This would usually be followed by examining the delicate structures of the eye one by one, checking the eye ball pressure ( by a tonometer ) and prescription of medications
If the eye’s internal pressure is elevated, eye drops may be prescribed to lower the pressure, to prevent glaucoma. The eye may be closed with a patch. If the injury is a serious one, the individual may be hospitalized for further treatment and monitoring eye pressure and corneal healing.
The recovery following a chemical injury, mainly depends upon the nature and extent of exposure to the injuring agent. If treated well on time and appropriately, most victims recover completely. However, it can bring on possible complications including glaucoma, swelling of the conjunctive and cornea, corneal damage, persisting and recurring redness, dry eye syndrome and scar tissue which can affect vision. In case of alkali burns, there may be permanent damage to the cornea and ongoing damage may occur inspite of prompt treatment. In extreme instances, it can lead to total loss of vision or blindness.
But the heartening fact is: eye injuries are preventable! The emphasis should be on prevention rather than treatment, as the mainstay of treatment because what we do after the injury, is only secondary, emphasizes Dr. Azim.
Dr. Azim enumerates certain preventive measures:
1. Follow package directions and warnings before using chemicals.
2. When using chemicals, always wear safety goggles / spectacles and protective clothing.
3. Avoid wearing long, flowing dress which may trip you when using such chemicals, as while transferring from a large containing into small bottles. This is more applicable to people handling bulk chemicals
4. Use an appropriate funnel while pouring such chemicals from one container to another.
5. While transferring chemicals into smaller bottles or containers, make sure not ever to pour such chemicals into an edible item bottle since there can be mistaken identity leading to accidental and serious problems.
6. Make sure that kids are not around you when you handle chemicals.
7. Don’t store these bottles along with other medical or edible items and keep them in a separate shelf out of reach of children, appropriately marked danger.
8. Don’t crowd the shelf with things in order to avoid accidental spillage while handling other items in the shelf
9. Keep the floor clean while handling chemicals to avoid slipping when handling such liquids.
10. As a precautionary measure, always keep a bucket of water close by while doing such work, to access water in case of a mishap.
11. Never peep into a drain while pouring chemicals.
12. If aerosols and other spray cans do not open, do not try to set them working by pricking at the hole, holding the can or container pointing towards you. The spray may get activated suddenly and spray the contents on to your face and eyes.
13. All chemical sprays in the home should be kept with their labels on and out of reach of small children.
14. Try not to use very corrosive chemicals at home.
15. Remember - anything that is strong enough to take the coating from metals, is strong to take the coating out of your eye, easily. So while using silver, gold and brass polish, be careful not to rub your eyes with your fingers before washing your hands clean off the polish.
Precautions to be taken while using fire crackers:
1. Buy only good quality crackers.
2. If any of them is not burning or has burned only partially, do not attempt to re-burn it.
3. Do not examine such a firecracker to see what’s happening by poking and pushing it. This is very commonly done with flowerpots! These crackers may explode half way and burst suddenly.
4. Pour water on half burnt crackers to make sure, they don’t get activated suddenly.
5. Some kids try to make their own firecrackers from burnt and half burnt ones. This is very dangerous because it can explode. Advice kids not to do this.
6. Direct rockets rockets away from body, in the open air and place the bottle in which they are kept, firmly and stably on the ground.
7. Wear proper, cotton dress and footwear while bursting crackers.
8. All kids must be supervised by adults while bursting crackers.
9. Keep a few buckets of water handy, should there be some mishap.
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