- Corneal epithelial damage: How much epithelium has been lost?
- Clarity of cornea: Can the normal structures (iris, pupil) be seen through the cornea?
- Limbal ischemia: Does the conjunctiva at the edge of the cornea appear normal or are there areas that are blanched white?

Grade I injuries may have corneal epithelial damage but a clear cornea, no corneal opacity, and no limbal ischemia.

These injuries generally carry a good prognosis for recovery. Irrigation and topical care are frequently the only required interventions.

Grade II through IV injuries will have corneal haze or opacity and limbal ischemia.

These injuries will have a guarded prognosis and will require more intensive treatment. Grading is determined by the most severe finding. For example, an eye with a clear cornea but showing limbal ischemia would be classified as grade II or higher.

Goals

Initiate eye irrigation as quickly as possible to reduce damage to the eye, treat the injury to prevent or reduce scarring and visual loss.

Minimum

- Immediate thorough irrigation to remove the chemical agent is the essential first step (IV fluid, sterile water, or clean water).
- Continue irrigation, using at least 2L of fluid.
- Use tetracaine eye drops as needed to facilitate irrigation (unpreserved lidocaine 2% can be substituted as eye drops if tetracaine is not available).
- Irrigation may not flush all chemical agents from the eye; examine for particulate matter and remove using a cotton tip applicator (CTA).
- Initiate pain control as needed. DO NOT use topical anesthetics for pain control; they significantly impair corneal healing.
- Initiate teleconsultation with photographs (include full facial views).