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If an accident occurs and you get a corrosive substance in your eye, it’s a case of seconds rather than minutes. It is important to quickly flush the eye, preferably with a buffered solution, and to keep doing so for a really long time. The worst ones are strongly alkaline substances such as caustic soda, but some acids can also seriously damage your eyes.
Anders Behndig is a professor and senior consultant at Umeå University and an expert on the front part of the eye. During his years as an eye specialist, he has met several patients who have had the misfortune of getting corrosive substances into their eyes, either at work or at home. And it is the patients who have had the opportunity to quickly flush their eyes that have fared the best.
“The most important thing when you get a corrosive substance in your eye is to start flushing the eye immediately. It is a case of seconds after the injury has occurred and it is important to keep going for a long time. This is absolutely crucial to whether the eye and vision survive or not.”
The pH value of the eyes is neutral, 7.4. At a pH of under 7.2 or above 7.8, you can already begin to feel an unpleasant irritating sensation. A pH below 4 or above 10, will result in serious injury.
“The most dangerous are corrosive substances, first and foremost alkaline ones with a pH value above 7.8. At home, you will usually find these in the cleaning cupboard, such as bleach, which is also called caustic soda, and some dishwasher detergents. In the workplace, the most common corrosive substances are alkalis and acids, such as bleach, sodium carbonate and ammonia,” says Anders Behndig and adds that even some acids, such as hydrochloric, nitric and sulphuric acids are also dangerous for the eyes.
How long you should flush depends on a number of things ranging from the type of corrosive substance you are dealing with, and when the injury occurred before you started flushing. The type of flushing solution used is also very important.
“If you start flushing the eye quickly and continue flushing for a long time, preferably 15 minutes or more, the body has a chance to repair the damage. The longer you flush the better, and if you suspect that it is a serious injury you should continue flushing until medical help arrives,” says Anders Behndig.
It is important to flush with a good flow of liquid and at a speed that is able to quickly lower the concentration of the corrosive substance and dilute and flush it away.
“The amount of liquid that is flushed into the eye is of great importance to how quickly a corrosive liquid is diluted and the PH is normalised. The flow of liquid is also important for the purely mechanical removal of the corrosive liquid in the eye, especially if the liquid contains solid particles, which is not unusual. The high flow of liquid cannot be achieved with, for example, spray bottles and the like, but a stronger continuous flow of liquid is required to achieve the intended affect,” says Anders Behndig.
The best thing to use is a so-called buffered flushing solution. This is a solution that neutralises the pH value in the eye more quickly than regular water or saline solution.
“If you get a strong corrosive substance in your eye, it is not enough to just flush it with water or saline solution, because this only has a mechanical effect. A buffered solution also neutralises the pH value and returns it more closely to the eye’s own pH value again,” says Anders Behndig.
“You can’t know this straight away. It can take days, sometimes weeks, before you can know how badly damaged the eye is. This is due, among other things, to the fact that the healing process in the case of damage caused by an alkaline substance is what we call ‘biphasic’, that is, the eye first becomes inflamed and red, then it can calm down after a few days and look better, only to then get significantly worse again,” says Anders Behndig.
Chemical eye injuries cause destruction, in whole or in part, of the biological tissues of the eye structure. This can be due to everything from an extreme pH value to the substance having oxidising or reducing properties.
“The worst injuries occur after accidents involving alkaline substances as they can penetrate deeply and damage the eye’s stem cells so that the cornea becomes cloudy and unclear, or they damage the eye’s conjunctiva so that adhesions form between it and the eyelid. This cannot be repaired with transplantation. Fortunately, these stem cells are so deep that you can flush away the dangerous substance before it has time to damage the stem cells and the eye can then heal. It all depends on how quickly you start flushing!
Text: Karin Cedronius