A patient gives a history of chuna falling into his eyes. All of the following would be a pa of his immediate management except:
(A) Irritation of both eyes with copious amounts of normal saline (B) Frequent sodium citrate drops (C) Thorough slit-lamp examination on presentation (D) Removal of chuna paicles by double eversion of upper eyelids
(C) Ans. c. Thorough slit-lamp examination on presentationImmediate Mananement of Chemical (Chuna-Powder) Injury: Irrigation of both eyes with copious amounts of normal saline Removal of chuna paicles by double eversion of upper eyelidsLids and fornices should be examined with double eversion of the lids and lime paicles should be removed with forceps; a cotton tipped applicator soaked in EDTA 1%deg."Chuna (strong alkali material) is used with tobacco. Bursting of chuna packet is one of the most common modes of ocular injury. Thorough slit lamp examination is not possible at presentation because of severe pain and blepharospasm. Thorough irrigation with saline and removal of chemical is most impoant. Irrigation of the cornea/conjunctiva/fornix with the lids held open with a speculum should be done until pH of tears shows neutrality. Lids and fornices should be examined with double eversion of the lids and lime paicles should be removed with forceps; a cotton tipped applicator soaked in EDTA 1%."- Yanoff and Ducker 's Ophthalmology; 3rd/e p349Chemical (Chuna-Powder) InjuryChuna (strong alkali material) is used with tobacco.Bursting of chuna packet is one of the most common modes of ocular injuryQ.Alkalis are more injurious to eye in comparison to acids as acids cause protein coagulation, which prevent fuher penetration of the chemical.Thorough slit lamp examination is not possible at presentation because of severe pain and blepharospasmQ.Thorough irrigation with saline and removal of chemical is most impoantdeg.Emergency Management of Chemical injury:Since duration of contact with chuna/chemical determines the extent of subsequent injury and prognosis, immediate copious irrigation is of the most impoanceQ.Irrigation of the cornea/conjunctiva/fornix with the lids held open with a speculum should be done until pH of tears shows neutralityQ.Lids and fornices should be examined with double eversion of the lids and lime paicles should be removed with forceps; a cotton tipped applicator soaked in EDTA 1%Q.If an acid burn is suspected, a base should not be used for irrigation in an effo to neutralize the acid.After copious irrigation, necrotic corneal epithelium should be debrided to promote re-epithelializationQ