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-Ocular Chemical Burns-
“Chemical burns to the eye are among the most urgent of ocular
emergencies…
Copious irrigation is the most important emergency treatment of the
chemically-burned eye…
This procedure probably has more of an influence on the outcome of the injury than any other therapeutic
approach.”
The Morgan Lens®
The World’s Leading Method of Ocular Irrigation
• Effective, easy to use ocular irrigation
• Frees medical personnel to treat other injuries
• Developed by a practicing ophthalmologist
• Used in 95% of U.S. emergency departments
Uses of the Morgan Lens• Alkali Burns• Acid Burns • Thermal Burns• Irritants (gasoline, detergents, etc.)• Non-embedded Foreign Bodies• Foreign Body Sensation With No Visible Foreign Body• Routine Pre-Operative• Eyelid Surgery
• Severe Infection
Alkali Burns (Bases)• Most Serious of all Ocular Burns• Penetrate Rapidly, increasing pH of anterior
chamber• Can cause severe damage to collagen, nerve
endings, keratocytes, iris, and ciliary body• Loss of corneal epithelium leads to increased
risk of infection• Common Sources That Contain Alkali:
– Lye (in drain cleaners)– Lime (in plaster, cement) – Ammonia (in fertilizers, cleaning agents)– Motor vehicle airbags
Acid Burns• Immediately denature proteins
– opacifies cornea and slows deep penetration
• Eye initially may look worse than alkali burn although damage often is not as severe
• Common Acids: hydrofluoric sulfuric sulfurous hydrochloric nitric acetic
• Most Common:– Industrial accidents and automobile battery explosions
• Hydrofluoric Acid Burns-very serious– Penetrate quickly and act like alkali burns
Irritants
• Cause more discomfort than actual damage
• Common Irritants:– Gasoline– Pepper Spray– Household Detergents
Irritants are substances with a neutral pH
Materials Necessary for Irrigation with The Morgan Lens
• 2 Morgan LensesNote: Pain in one eye may mask pain in other--irrigate both unless injury is known to be limited to one eye.
• Morgan Lens Delivery Set® (or I.V. set)• Suitable Irrigation Solution (lactated Ringer’s
recommended)
• Medi-Duct® (or towels) to absorb outflow• Topical ocular anesthetic if available • pH paper
INSERTIONStep One:
• Instill topical ocular anesthetic (if available)
• Attach Morgan Lens to Morgan Lens Delivery Set or syringe or I.V. tubing
**If possible, remove contact lenses (if necessary) BEFORE starting irrigation. Irrigate over contacts if unable to remove. Removal may be easier after a period of irrigation.
INSERTION
• Have patient look down• Insert Lens under upper lid• Have patient look up, retract
lower lid, drop Lens in place
*Solution acts as a cushion, suspending the Lens above the cornea and protecting injured surfaces from the eyelids.
Step Two:Step Two: Start Minimal Flow Start Minimal Flow BEFORE* Inserting LensBEFORE* Inserting Lens
INSERTION Step Three:
• Secure a fluid collection device such as the Medi-Duct to the side of patient’s face
• Continue irrigation until pH of eye returns to normal
DO NOT RUN DRYTape tubing to patient’s forehead to prevent accidental removal
REMOVAL• Continue flow • Have patient look up• Retract and hold lower lid
• Slide Morgan Lens outSlide Morgan Lens out
TERMINATE FLOWTERMINATE FLOW
Irrigation Times•For Irritants:
-20 to 30 minutes minimum
•For Acids and Alkalis:--Irrigate with 2 liters fluid per eyeIrrigate with 2 liters fluid per eye
-Wait 5-10 minutes-Wait 5-10 minutes
-Measure pH of cul-de-sac-Measure pH of cul-de-sac
-Repeat until pH is between 7.5 and 8-Repeat until pH is between 7.5 and 8
For strong acids or any alkali, continue irrigation for 2 hours after reaching surface pH of 8 to ensure neutralization of anterior chamber
Questions for PatientsDo NOT delay irrigation to take patient history*
• When did injury occur?• What substance was involved?• Is the patient on any medication or allergic to any
medications?• Was the patient wearing safety glasses when injury
occurred?• Are there any other injuries?• Did patient receive any prior treatment?
From Nursing 2000, Volume 30, Number 8
*Removal of contact lenses (when necessary) before starting irrigation should be done ONLY IF IT DOES DELAY irrigation—
removal may be easier after a period of irrigation.
Contraindications
• Protruding foreign body• Penetrating eye injury• Suspected or actual rupture of the globe• Instilling anesthetic agents with known
allergies
Lactated Ringer’s vs. Normal Saline
MorTan recommends the use of lactated Ringer’s
• pH more like that of tears– pH of tears: approximately 7.1– pH of lactated Ringer’s: 6.0 to 7.5– pH of Normal Saline: 4.5 to 7.0
• High buffering capacity– lactated Ringer’s solution returns pH to neutral more quickly with either
acidic or basic contaminants*
• Increased patient toleranceNormal Saline may cause discomfort and/or morphological changes*
*from independent studies
Suggestions for the Suggestions for the ““Difficult Patient”Difficult Patient”
Reassure patient: insertion will Reassure patient: insertion will quicklyquickly relieve pain. relieve pain.Any delay will cause further damage. Any delay will cause further damage.
Seconds count!Seconds count!
•Irrigating solution provides soothing sensationIrrigating solution provides soothing sensation•Injured cornea is separated from “squeegee” action of eyelidsInjured cornea is separated from “squeegee” action of eyelids•Eye may be closed during procedureEye may be closed during procedure•Some chemicals generate heat when mixed with water-irrigation Some chemicals generate heat when mixed with water-irrigation cools cools •Note: Cornea will not be touched by Morgan LensNote: Cornea will not be touched by Morgan Lens
Topical anesthetic may relieve anxietyTopical anesthetic may relieve anxiety
Note: Additional anesthetic may be instilled without removing Lens. Pinch tubing and instill drop into cul-de-sac.
Benefits of the Morgan Lens
• 100% of irrigating solution is delivered directly to cornea, cul-de-sac and conjunctiva
• Frees medical staff to attend to other injuries• Patient can be ambulatory during irrigation • Patient rests comfortably• Highly cost effective
Summary• Burns are among the most urgent of ocular emergencies• Copious irrigation must be started quickly (at scene of
accident if possible)• All surfaces of eye (cornea, sclera, cul-de-sac, and inner
eyelid) must be flushed thoroughly• Irrigation should be continued until pH of eye returns to
normal (alkali burns may require hours of irrigation; severe infections may require irrigation for hours or even days)*
*See MORGAN LENS USES CHART available on MorTan’s website or from MorTan
The Morgan LensThe World’s Leader in Ocular Irrigation
To order or for more information contact:
MorTan, Inc.
P.O. Box 8719
Missoula, MT 59807 USA
Phone: (406) 728-2522
1-800-423-8659
Fax: (406) 728-9332
www.morganlens.com email: [email protected]© 2011 MorTan, Inc. MorTan is an ISO 9001/13485 registered
company Do not duplicate or modify without permission from MorTan, Inc.