NCLEX Review Guide: Chemical Burns to the Eye

Priority Actions for Chemical Eye Burns

• IMMEDIATE irrigation is the TOP priority - Begin within 15 seconds of exposure to prevent permanent damage and blindness.
• Use copious amounts of normal saline or sterile water for at least 15-20 minutes, directing flow from inner to outer canthus.
• Remove contact lenses if present and easily removable, but DO NOT delay irrigation to search for or remove lenses.
• Check and document visual acuity before and after treatment using Snellen chart or finger counting.

Alkali vs. Acid Burns Comparison

1. Assess corneal clarity - cloudiness indicates severe damage
2. Evaluate pupil response and shape
3. Check for conjunctival blanching (white appearance indicates ischemia)
4. Document extent of epithelial defects using fluorescein staining
5. Monitor intraocular pressure - may be elevated or decreased

Post-Irrigation Care

• Administer prescribed topical antibiotics (erythromycin, bacitracin) to prevent secondary infection.
• Apply cycloplegic agents (atropine, homatropine) to reduce pain from ciliary spasm and prevent synechiae formation.
• Use topical steroids cautiously - may delay healing in severe burns but reduce inflammation in mild cases.
• Provide systemic pain management with acetaminophen or NSAIDs as prescribed.

Discharge Teaching

• Teach proper technique for instilling prescribed eye drops, emphasizing hand hygiene and avoiding contamination of dropper tip.
• Instruct to report immediately: sudden vision changes, severe pain, discharge, or flashing lights.
• Emphasize importance of follow-up appointments to monitor healing and detect complications early.
• Provide education about workplace safety measures including proper use of protective eyewear and emergency eyewash stations.