A factory worker sustains a lime (calcium hydroxide) splash to both eyes. The FIRST and MOST CRITICAL immediate management step is:
- A Copious irrigation with normal saline or water for at least 20–30 minutes and pH normalisation ✓
- B Apply topical antibiotic and refer to ophthalmologist within 6 hours
- C Instill EDTA eye drops to chelate calcium deposits
- D Cycloplegic and steroid drops immediately
Correct answer: A. Copious irrigation with normal saline or water for at least 20–30 minutes and pH normalisation
Explanation
Alkali burns (pH > 11) such as lime, ammonia, and lye are ocular emergencies because alkalis cause liquefactive necrosis with deep penetration into the stroma, anterior chamber, and even the lens. The single most important and urgent measure is immediate, copious irrigation for 20–30 minutes (at least 2 litres) to dilute and remove the alkali and restore pH to 7.0–7.4. Treatment delay worsens prognosis dramatically. EDTA is used later for calcific band keratopathy; antibiotics and cycloplegics are adjuncts after irrigation.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.