eye disorders
How To Irrigate the Eye and Do Eyelid Eversion
Step by Step Description of Eye Irrigation and Eyelid Eversion
Immediate initiation of irrigation is the prime objective when treating chemical ocular burns. Defer other parts of evaluation and treatment, even normally preliminary tasks, including external examination of the eye and rudimentary assessment of visual acuity, until after irrigation. Whenever possible, check the pH of the eye before irrigation, by touching the lower fornix with a piece of pH paper or the pH strip from a urine dipstick. If pH paper is not immediately available, check pH as soon as possible after beginning irrigation. Normal pH of the eye as measured with pH paper is about 7.0. Ask the patient to look upward, and then place a drop of topical ocular anesthetic into the inferior fornix of the affected eye. Tell the patient to keep the eye closed until the irrigation begins, in order to retain the drug. Drops may need to be re-instilled every 5 to 10 minutes during irrigation. If particulate material may be in the eye and significant chemical exposure is unlikely, sweep potential particulate matter out with a moistened cotton-tipped applicator before irrigation. Sweep both the inferior and superior fornices. In one hand, hold the end of the IV tubing about 3 to 5 cm from the eye. Fully open the tubing to achieve optimal irrigation flow. Direct the irrigation stream over the entire surface of the eye, including both the inferior and superior fornices and the cornea. The stream should flow over the surface and should never be pointed directly at the cornea. Retract the eyelids to adequately irrigate the fornices. Use the hand that is not holding the IV tubing; or an assistant with gauze pad in each hand can retract the lids. An eyelid retractor may also be used, particularly if blepharospasm is present. An eyelid retractor can cause pain that requires treatment (usually treatable with topicalproparacaine). When treating a chemical burn, also rapidly flush the skin surfaces of the eyelids and periorbital area to remove lingering chemicals. The duration of irrigation depends on the clinical scenario and must continue until the pH is normalized. In many cases, 15 to 20 minutes of irrigation are required and several liters of irrigant are often used. In acid and, particularly, in alkali burns, some experts suggest 1 to 2 h of irrigation. With alkali burns, irrigation may need to continue for many hours. For prolonged irrigation (eg, > 15 minutes), consider using a The scleral lens . Consider adding 10 mL of 1% Check the pH of the eye(s) when irrigation is finished. If the pH is not normal, continue irrigation. If the pH is normal, re-check it after another 20 minutes to see whether irrigation should be started again because chemicals can continue to leach out of the tissue and alter what appeared to be a normalized pH. 