Most red eyes are conjunctivitis and most conjunctivitis is self-limited, so the whole clinical skill is finding the minority that will blind the patient — and finding it before you finish the history. A chemical splash is the one ophthalmic situation where you act before you assess. Run the splash, sort the red eye, decide what you must never do to a ruptured globe, and get the drop technique right.
14:02 — a worker is brought inIndustrial drain cleaner splashed into both eyes on a loading dock four minutes ago. His eyes are clamped shut, he is shouting, and the ophthalmology resident is five minutes away.
Step 1 · What do you do in the first ten seconds?
Step 2 · What was it?
Step 3 · Run the irrigation
Minutes irrigated0 min
Technique: normal saline or lactated Ringer solution — or plain water if that is what is within reach at the moment of injury. Direct flow from the inner canthus outward so runoff does not cross the other eye.
Four findings should stop you every timeSignificant pain rather than irritation. Reduced visual acuity. Photophobia. A ciliary flush — redness concentrated in a ring around the cornea rather than spread diffusely toward the lids. Build the eye and see where it lands.
Where is the redness?
What does it feel like?
Discharge
Acuity and history
Choose the patient
Nine steps, in orderDrop technique changes drug delivery more than most dose adjustments do. Click the steps in the order you would perform them. Two of them are the ones nurses get wrong every day.
The clock and the pH
Where this eye lands
And two rules that never bend. Never patch an eye that may be infected, and never patch a contact-lens wearer's eye — a patch turns the closed lid into a warm moist incubator, and in Pseudomonas keratitis that is a cornea lost overnight. When in doubt, shield rather than patch. Topical anaesthetics are never sent home, because repeated use prevents epithelial healing.