A 28-year-old construction worker presents with severe pain, blepharospasm, and whitening of the conjunctiva and cornea immediately after splashing of a cement slurry (alkaline) in his eye. The MOST important IMMEDIATE management step is:
- A Immediate and copious irrigation with water or normal saline for at least 30 minutes, continuing until pH normalizes to 7.0–7.4 ✓
- B Measurement of pH and application of buffered eye drops
- C Referral to ophthalmologist for limbal stem cell transplantation
- D Application of topical corticosteroids to reduce inflammation
Explanation
For chemical eye injuries, immediate and prolonged irrigation with water or normal saline is the single most important emergency intervention — this must be started without delay and continued for at least 30 minutes (or until pH normalizes). Alkali (pH >7) causes liquefactive necrosis, rapidly penetrating through the corneal stroma into the anterior chamber. The longer the alkali contact time, the deeper the penetration. pH check with litmus or pH strip guides endpoint of irrigation (pH 7.0–7.4). Corticosteroids are a secondary treatment. Limbal stem cell transplantation is a later consideration for severe injuries.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.