Ectopic Pregnancy — USMLE Step 2 CK MCQ

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MediumObstetrics & GynecologyEctopic PregnancyUSMLE Step 2 CK

A maintenance worker arrives minutes after concentrated drain cleaner splashed into his right eye. He has severe pain, blepharospasm, conjunctival whitening, and blurred vision. Ocular-surface pH is 11.0. No treatment has yet been given. Which action should be performed first?

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Correct answer: B — Begin copious irrigation immediately and continue until pH is physiologic

An alkali ocular burn is an immediate vision-threatening emergency because alkali penetrates ocular tissues and continues causing liquefactive injury. Copious irrigation must begin at once and must not be delayed for visual-acuity testing, a complete slit-lamp examination, or transfer. Topical anesthetic and an eyelid speculum may facilitate irrigation. The fornices should be swept for retained particulate matter, and irrigation should continue until ocular-surface pH is approximately 7.0–7.2 and remains stable after stopping. Attempting chemical neutralization with an acid can generate heat and worsen tissue damage. Eye patching permits ongoing exposure and delays essential reassessment. Antibiotic, cycloplegic, anti-inflammatory, pressure-lowering, and surface-healing therapies may be indicated after decontamination and ophthalmologic evaluation, but none supersedes irrigation. Once irrigation is underway and pH is corrected, document visual acuity, assess limbal ischemia and epithelial defects, measure intraocular pressure when safe, and obtain urgent ophthalmology involvement.

Reference: American Academy of Ophthalmology EyeWiki. Chemical Injury of the Conjunctiva and Cornea. https://eyewiki.aao.org/Chemical_%28alkali_and_acid%29_injury_of_the_conjunctiva_and_cornea