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Eye injury - Irrigation

Question Type:
Intervention
Full Question:
Among adults and children who have a chemical or other unknown substance enter the conjunctival sac (P), does irrigation with isotonic saline, balanced salt solution or other commercial eye irrigation solutions (I), compared with compared with irrigation with water (C), change PH level, Intraocular penetration, Corneal thickness (swelling), Intraocular pressure, Reduce the risk of secondary glaucoma, Dilution of irritant (O)?
Consensus on Science:
Saline (I) Compared With Water (C) For the critical outcome of pH level, studied as maximum pH of the anterior chamber after alkali application to the cornea, we identified very-low-quality evidence (downgraded for indirectness and imprecision) from 1 in vivo observational animal study(Kompa 2005, 467) using the eyes of 16 rabbits divided into 4 groups of 4 rabbits (8 eyes) in which twice normal sodium hydroxide (2N NaOH) was applied to the corneas, demonstrating benefit (ie, in reduction of the high, alkaline pH) with irrigation using water, including • A statistically significant higher maximum pH when irrigating with 0.5 L of 0.9% normal saline versus 0.5 L of tap water (MD, 0.62; 95% CI, 0.25–0.99) • A statistically significant higher maximum pH when irrigating with 1.5 L of 0.9% normal saline versus 0.5 L tap water (MD, 0.57; 95% CI, 0.035–1.105) • A statistically significant higher maximum pH when irrigating with 0.5 L of 0.9% normal saline versus 1.5 L of tap water (MD, 0.5; 95% CI, 0.119–0.881) No significant difference in maximum pH was found after irrigation using 1.5 L of 0.9% normal saline versus 1.5 L of tap water (MD, 0.45; 95% CI, −0.09 to 0.994). We did not identify any evidence to address the outcomes of intraocular penetration, risk of secondary glaucoma, corneal thickness (swelling), or intraocular pressure.
Treatment Recommendation:
We suggest that first aid providers use continuous, large volumes of clean water for irrigation of chemical eye injuries (weak recommendation, very-low-quality evidence). We did not identify any studies evaluating the use of irrigation for other substances entering the eye comparing irrigation solutions with water. Values, Preferences, and Task Force Insights In making this recommendation, we value the preservation of vision. We recommend that the local poison center be called to assist with identification of any chemical involved in an ocular injury. Because of the dangers associated with chemical eye injuries, a healthcare professional should evaluate these injuries immediately. Public comments expressed concern that our recommendation could be made based on a single animal study. This is a valid concern. However, although the included animal study is of a very-low-quality evidence, it is important because it demonstrates the extreme caustic nature of an alkali injury to the cornea and the need to irrigate with large volumes of water. The included study showed persistently high pH levels of the alkali-injured corneas at 3 hours after irrigation with 1.5 L of either saline or water. Thus, based on this single study, we again recommend continuous irrigation of corneal injuries caused by alkaline substances with clean or tap water and to continue until a healthcare professional evaluates the injury and determines that the pH of the eye has returned to normal.
CoSTR Attachments:
Data Extraction - Eye Irrigation 1-20152.xlsx    
GRADE Tables for evaluation of value of 0.9 per cent saline solution irrigation versus tap water.pdf    
PICO 540 - Data Extraction - Kompa 2005.pdf    
PICO 540 - Eye Irrigation - Consensus on Science and Treatment Recommendations.pdf    
SoF Tables (version 2) for evaluation of value of 0.9 per cent saline solution irrigation versus tap water.pdf    

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