Pediatric emergency medicine trisk 4054 4054
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not delay lavage while waiting for either of these adjunctive therapies. Usually,
the irrigating solution itself will induce cold anesthesia. If active manual
irrigation is performed, the eyelids must be retracted for maximal exposure of the
cornea and conjunctiva. A speculum or Desmarres retractor may be used to help
obtain optimal exposure.
A typical eye irrigation setup includes an IV pole and a 1 L normal saline IV
bag attached to a tubing set without a needle on the end. While the provider holds
the distal end of the tubing over the patient’s eye the irrigation solution is allowed
to flow, with the system at its maximum flow rate, across the surface of the open
eye from medial to lateral. If both eyes have been exposed, a set of nasal cannula
prongs can be attached to the IV tubing and then the prongs can be taped over the
patient’s nasal bridge (each prong directed at the medial aspect one eye). Both
eyes can then be easily lavaged simultaneously. The Morgan Lens is a
commercially available sterile plastic device that resembles a contact lens. It fits
over the eye and can be connected to tubing that allows for continuous flow of
fluid on to the ocular surface ( Fig. 123.12 ). It is quick and easy to set up and
provides a “hands-free” method of irrigating the cornea and conjunctiva. A
mechanism to collect excess fluid (such as towels, suction, basins, etc.) should be
in place. Virtually any IV fluid can be used for ocular lavage, although normal
saline solution is most commonly used. The use of more pH neutral solutions
(Ringer’s lactate, NS with bicarbonate buffer, or a balanced salt solution) may
decrease ocular discomfort and irritation associated with irrigation. Regardless of
the method used, lavage should be continued until the involved eye(s) has
received either 2 L of fluid or until approximately 20 minutes have elapsed. Lid
eversion should be performed (see Chapter 114 Ocular Trauma , Fig. 114.2 ), and
lavage should be continued with the lid in this position so that the conjunctiva
under the upper lid may also be cleansed. Mechanical debridement should be
limited to the removal of visible particles from the ocular surface, which may
contain small amounts of the offending agent or necrotic debris.
After irrigation is performed as described above, the pH should be remeasured
every 15 to 30 minutes to determine whether it has normalized (pH 6.5 to 7.5)
and is equal between the two eyes. The end point of equality should only be used
if one eye has not been exposed to caustic chemicals. The conjunctiva under the
upper lid may also be tested separately because noxious material can be harbored
in the recess above the eye under the lid. Irrigation should continue until
normalization of pH has been achieved.
