Clinical audit on acute management of ocular chemical injury

Abstract

Aim: To assess the acute management of ocular chemical injuries to all patients who attended the eye casualty and compare this management with the standard protocol of chemical eye injury. Methods: Retrospective review of all cases with ocular chemical injury over a period of 4 months (August 2010 to November 2010). Case -files were retrieved and relevant information was extracted and analyzed. The audit was registered with the clinical effectiveness department of the author's trust. Results: There were a total of 72 patients under review during the study period consisting of 54 males and 18 females. Ages ranged from 3–85 years. The major cause of chemical eye injury was work related. However, other causes such as school, university and home accidents and assaults were noticed. The severity of ocular injury and damage was noted on reading of the pH value, as were the delay of the ocular irrigation, the amount of the chemical the patient had been exposed to and the duration of exposure. Additionally, the mismanagement of cases by the medical team was also noted in some cases. Conclusion: The major cause of chemical eye injury presenting to the Birmingham Eye Hospital was work related. The degree of the chemical eye injury varies, however, the disability and blindness caused seems to be more in the assault cases. In order for there to be a good prognosis in managing the chemical eye injury there is a need for effective assessment and examination. This would involve the prompt irrigation for all patients who attend the eye casualty complaining of chemical eye injury. Additionally, both eyes should undergo detailed examination which would include rapid afferent papillary defect (pupil reaction), intraocular pressure and fundus checks (particularly in severe cases). The effectiveness of the management includes the use of preservative-free topical medications for all patients, which includes the use of topical antibiotics and lubricants. Also the use of the topical steroid and systemic oral medications should be indicated in severe chemical eye injury cases. Effective follow up and understanding of cases of chemical eye injury requires detailed documentation following examination, assessment and management of patients' chemical eye injuries. The documentation could involve medico-legal aspects for the assault cases, and practitioners should understand these, and detailed documentation is useful should there be complaints against the hospital and medical team.