Characteristics, management and outcomes of chemical eye injuries in Victoria

To the Editor: Chemical eye injuries are an ophthalmic emergency that can potentially result in visual impairment.1 A retrospective audit was performed to determine the characteristics, management and outcomes of chemical eye injuries in patients presenting to the Royal Victorian Eye and Ear Hospital (RVEEH).

The records of 176 patients who presented to the emergency department between 1 July 2012 and 31 December 2012 were analysed. The average age was 41 years (range, 7–85 years), with 110 (62.5%) being male. Forty-six patients (26.1%) had bilateral injuries. The characteristics, management and outcomes of injuries are outlined in the Box. Eighty-two injuries (46.6%) occurred at home, and 65 (36.9%) occurred in the workplace. Men accounted for 40 (48.8%) of the injuries that occurred at home and 52 (80.0%) of the workplace injuries. In 65 injuries (36.9%), cleaning was the activity at the time of injury. Of these, 33 injuries (50.8%) occurred at home and 24 injuries (36.9%) occurred in the workplace. At the time of injury, 123 patients (69.9%) were not wearing eye protection, with nine (5.1%) wearing spectacles alone. The causative agent was alkaline in 114 cases (64.8%).

One-hundred and thirty-eight injuries (78.4%) were irrigated before arrival to hospital, and 132 patients (75.0%) required further irrigation on presentation to the RVEEH to neutralise the pH. Using the Roper-Hall classification,2 most were mild injuries (92.6% were grade 1; 3.5% were grade 2; 1.7% were grade 3; 0 were grade 4 (the other 2.2% could not be determined from the notes). All injuries were managed medically. The median visual acuity at discharge was 6/6, and one injury was complicated by corneal scarring.

Similar to findings of previous studies,1,3 two-thirds of chemical eye injuries in Victoria occurred in men. While most injuries in men occurred at the workplace, both sexes were almost equally represented in injuries occurring at home. Most patients were not wearing any form of eye protection at the time of injury. Although there has been promotion and an increased awareness of the importance of protective eyewear,4 more education and reinforcement are warranted to reduce the incidence of chemical eye injuries.

Removal of particulate matter after injury and prompt irrigation, either with Hartmann's solution or normal saline, until the pH of the injured eye is neutral are the most vital steps that can reduce the development of complications and improve visual outcomes.1,5 Our study suggests that although there was awareness of the importance of irrigation, many patients were still not receiving irrigation with adequate volumes. General practitioners and emergency medicine doctors are the initial point of contact in 40.9% of injuries and should be encouraged to not only adequately irrigate, but increase the awareness of preventive measures.

Prevention and early treatment of chemical eye injuries are vital. This can be achieved through increased awareness of the dangers of chemicals, careful handling of chemicals, wearing of protective eye-wear and immediate irrigation after injury. These are important public health messages that need to be continually emphasised.