The acute red eye — KFP-style written assessment

KFP 1 (10 marks)

A factory worker splashes a cleaning solution (containing sodium hydroxide) into his right eye. He arrives at your practice within five minutes. His eye is red, watering profusely, and he cannot open it. He is in severe pain. ^[4]

1. What is your immediate action? Justify with reference to alkali versus acid penetration. (5) ^[4]
2. How long should irrigation continue and what should you check afterwards? (3) ^[4]
3. What is the disposition? (2) ^[4]

Model answers

1. Irrigate immediately with copious normal saline or clean water. Alkali chemicals saponify lipid cell membranes and penetrate the cornea within minutes, continuing to damage tissue until neutralised. Acids coagulate surface proteins forming a partial barrier; alkalis do not. Do not delay irrigation for history-taking or visual acuity testing. ^[4]
2. Continue irrigation for at least 15–30 minutes. After irrigation, check pH (aim for neutral 7.0–7.4) using litmus paper, evert lids to remove retained particles, then recheck pH. ^[4]
3. Urgent transfer to hospital even if pain improves after irrigation, because deep tissue damage may not be immediately visible. Continue irrigation during transfer. ^[4]