-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.”

“Prompt Irrigation of Chemical Eye Injuries May Avert Severe Damage”, Frank R. Burns, MD Occupational Health & Safety, April, 1989

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 which 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 pHIrritants 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®

• I.V. 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. If possible, remove contact lenses (if necessary) BEFORE starting irrigation. Irrigate over contacts if unable to remove. Removal may be easier after a Irrigate over contacts if unable to remove. Removal may be easier after a period of irrigation. 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 *Solution acts as a cushion, suspending the Lens above the cornea and protecting injured surfaces from the eyelids.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 DRY

Tape tubing to patient’s forehead to prevent accidental removalTape 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

*Recommendation from *Recommendation from Goldfrank’s Toxicologic EmergenciesGoldfrank’s Toxicologic Emergencies

•For Irritants: -20 to 30 minutes minimum

•For Acids and Alkalis:-Irrigate with 2 liters fluid per eye-Irrigate 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 For strong acids or any alkali, continue irrigation for 2 hours after reaching surface pH of 8 to ensure neutralization of after reaching surface pH of 8 to ensure neutralization of anterior chamber*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

**If possible, remove contact lenses (when necessary) BEFORE starting If possible, remove contact lenses (when necessary) BEFORE starting irrigation but DO NOT DELAY irrigation--removal may be easier after a irrigation but DO NOT DELAY irrigation--removal may be easier after a

period of irrigation.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 “squeegie” action of eyelidsInjured cornea is separated from “squeegie” action of eyelids•Eye may be closed during procedureEye may be closed during procedure•Some chemicals generate heat when mixed with water-irrigation cools Some chemicals generate heat when mixed with water-irrigation 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. Note: Additional anesthetic may be instilled without removing Lens. Pinch tubing and instill drop into cul-de-sac.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 Leader in Ocular Irrigation

• MorTan, Inc.P.O. Box 8719Missoula, MT 59807 USA1-800-423-8659

1-406-728-2522FAX 1-406-728-9332www.morganlens.com

e-mail: mortan@morganlens.com

© 2002 MorTan, Inc. MorTan is an ISO 9001 registered company© 2002 MorTan, Inc. MorTan is an ISO 9001 registered company

Do not duplicate or modify without permission from MorTan, Inc.Do not duplicate or modify without permission from MorTan, Inc.

Advance to the next slide for the Morgan Lens Instructional Video

Morgan Lens Instructional Video

Double-click on the above box to view the Morgan Lens Double-click on the above box to view the Morgan Lens Instructional Video. Instructional Video.

(Note: if the video does not play, double-click on “My Computer” and double-click on the icon for the CD-ROM. From there, open the file (Note: if the video does not play, double-click on “My Computer” and double-click on the icon for the CD-ROM. From there, open the file “mlvideo.mpg”)“mlvideo.mpg”)