This patient-education article is written by the cornea service at Suraj Eye Institute, Nagpur.

What is a Chemical Eye Injury?

A chemical eye injury occurs when an acid, alkali or other corrosive substance contacts the eye. It is one of the few true ophthalmic emergencies in which what is done in the first few minutes — long before reaching hospital — decides whether the eye is saved. Alkalis are more dangerous than acids: they penetrate the eye rapidly by dissolving cell membranes (saponification), whereas acids tend to coagulate surface proteins, which partly limits how deep they reach.

In central India the common agents include lime (chuna / calcium hydroxide, used in whitewash and in betel/paan), household cleaners and detergents, agricultural chemicals and fertilisers, and industrial acids and alkalis.

⚠ IMMEDIATE FIRST AID — IRRIGATE AT ONCE. The single most important treatment is immediate, copious irrigation with clean water or saline for at least 15–30 minutes, started at the scene before travelling to hospital. Hold the eyelids open and let water run gently but continuously across the eye. Do not waste time searching for a special solution — clean tap water is appropriate. Do not try to neutralise an acid with an alkali, or the reverse.

Why the Limbus Matters

The limbus — the ring where the clear cornea meets the white sclera — holds the stem cells that continuously renew the corneal surface. In a chemical burn, the area of limbus that is blanched and ischaemic (cut off from its blood supply) is the best single predictor of the eventual outcome. The more limbus that is damaged, the poorer the healing and the higher the risk of permanent scarring and surface failure.

Limbal Ischaemia and Prognosis in Chemical Injury The Limbus Predicts the Outcome of a Chemical Burn The limbus (ring around the cornea) holds the stem cells that heal the surface. White = ischaemic (no blood supply).

MILD (Grade I) Limbus fully perfused (pink) Clear cornea Good prognosis

MODERATE (Grade II–III) Partial limbal whitening (here ~4–5 clock hours) Guarded prognosis

SEVERE (Grade IV) Most of the limbus white Opaque (“cooked”) cornea Poor prognosis

Figure 1. The amount of limbal ischaemia — whitening of the ring where the cornea meets the white of the eye — is the single best predictor of outcome after a chemical burn. The limbus carries the stem cells that resurface the cornea. A fully perfused pink limbus (left) heals well; partial whitening (centre) carries a guarded prognosis; extensive limbal whitening with an opaque cornea (right) heals poorly and may need stem-cell transplantation. This is the basis of the Roper-Hall and Dua grading systems.

How Severity is Assessed

After irrigation, the eye is examined and graded by the extent of limbal ischaemia and conjunctival involvement, using the Roper-Hall and Dua grading systems. Grading guides treatment and gives a realistic indication of prognosis.

Treatment

  • Continued irrigation until the surface pH returns to normal
  • Intensive lubrication and topical antibiotics to protect and support the healing surface
  • Topical steroids in the early phase to control inflammation, carefully timed and supervised
  • Ascorbate (vitamin C) and citrate drops, and oral vitamin C, to support corneal healing
  • Amniotic membrane transplantation for moderate-to-severe burns, to reduce inflammation and limit scarring
  • Limbal stem cell transplantation and ocular surface reconstruction for severe burns with stem-cell loss, usually performed months later
Prevention. Protective eyewear when handling lime, cleaning agents, fertilisers and industrial chemicals prevents the great majority of these injuries. Workplaces that use corrosive chemicals should have an eyewash station and a clear “irrigate immediately” protocol.
✔ Chemical Injury Care at Suraj Eye Institute

Our service treats chemical eye injuries as emergencies — immediate irrigation, pH-guided assessment, grading of limbal ischaemia, intensive medical therapy and early amniotic membrane transplantation for moderate-to-severe burns. For severe burns with stem-cell loss we offer ocular surface reconstruction and limbal stem cell transplantation as part of long-term rehabilitation.

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Frequently Asked Questions

How long should I wash the eye after a chemical splash?
For at least 15–30 minutes of continuous irrigation with clean water or saline, started immediately at the scene. If a litre or more of clean water is available, keep going while someone arranges transport. The longer the chemical stays in contact with the eye, the worse the damage.

Are alkalis really worse than acids?
Yes. Alkalis (lime, caustic soda, ammonia) dissolve cell membranes and penetrate deep into the eye within minutes, so they cause more severe and progressive damage. Acids tend to coagulate the surface, which partly limits penetration — though strong acids can still cause severe burns.

Should I try to neutralise the chemical?
No. Never try to neutralise an acid with an alkali or vice versa — the chemical reaction generates heat and causes further injury. Plain clean water or saline is the correct and only first-aid irrigation fluid.

Will my vision recover after a chemical burn?
Mild burns, where the limbus is undamaged, usually recover well. Moderate-to-severe burns with limbal damage heal more slowly and may leave scarring or surface problems that need further treatment, including amniotic membrane or stem-cell surgery. Early, prolonged irrigation gives the best chance of a good outcome.

My eye feels better after washing — do I still need to be seen?
Yes. Even if the eye feels more comfortable after irrigation, the true severity can only be judged by examining the limbus and measuring the surface pH. Any chemical eye injury should be assessed by an eye specialist the same day.

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