Chemical Eye Burn Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Irrigate immediately; grade the injury
   Immediate copious irrigation to a neutral pH (priority, do not delay); after irrigation, corneal opacity/limbal ischemia? (A true ophthalmic emergency. Alkali is worse than acid (alkali → liquefactive necrosis, saponification, deep penetration, irreversible at pH >11.5; acid → protein coagulation forming a barrier, shallower). Severe pain/photophobia/blurred vision/foreign-body sensation; a painless white eye = limbal ischemia (severe, not a reassuring sign); Roper-Hall grades by corneal opacity + limbal ischemia. Immediate copious irrigation is the most important first aid, do not delay for anything (water/saline/lactated Ringer, continue until the conjunctival sac pH is neutral 7.0–7.4, may need large volumes, longer for alkali); do not neutralize acid and alkali against each other.)
   • Severe (corneal opacity/limbal ischemia/painless white eye, Roper-Hall III–IV) → Severe → continuous irrigation + urgent ophthalmology
   • Mild (clear cornea, limbal ischemia <1/3, Roper-Hall I–II) → Mild · topical therapy after irrigation
2. [End] Mild · topical therapy after irrigation
   Mild (Roper-Hall I–II, clear cornea, limbal ischemia <1/3): ensure irrigation to a neutral conjunctival sac pH (7.0–7.4), evert the lids and remove particles; topical broad-spectrum antibiotic + preservative-free lubricant + cycloplegic ± short-term steroid; analgesia, ophthalmology follow-up; monitor epithelial healing.
3. [End] Severe → continuous irrigation + urgent ophthalmology
   Severe (corneal opacity, limbal ischemia, painless white eye, Roper-Hall III–IV): continuous copious irrigation to a neutral pH (alkali may need large volumes/longer), evert the lids and thoroughly remove particles (lime/cement calcium soaps hide in the upper fornix); urgent ophthalmology consult; intensive therapy — topical antibiotic + preservative-free lubricant + cycloplegic + steroid + vitamin C/citrate (anti-collagenase) + IOP control; severe cases amniotic membrane/limbal stem cell transplant. Do not neutralize acid and alkali against each other.

Source guidelines & references

• Chemical eye burn (AAO; Roper-Hall classification; StatPearls)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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