Septic shock — MCCQE Part 1 MCQ

Correct answer: C — Begin copious continuous ocular irrigation immediately and continue until surface pH is physiologic

An alkali ocular burn is a true emergency because liquefaction injury permits rapid, deep penetration. Start copious irrigation immediately; do not delay for formal visual-acuity testing, slit-lamp examination, imaging, identification of the exact concentration or arrival of a preferred fluid. Normal saline or balanced crystalloid is suitable, but clean water is preferable to waiting. Topical anaesthetic may facilitate irrigation. Continue while everting the lids and removing retained particulate material, then recheck ocular-surface pH after a brief pause and resume irrigation until it remains physiologic. Once decontamination is complete, document visual acuity, assess the cornea, limbus, conjunctiva, intraocular pressure and fornices, and obtain urgent ophthalmology input for grading and subsequent therapy. Antibiotics, cycloplegia and anti-inflammatory treatment may be indicated later but cannot substitute for immediate dilution and removal of the caustic agent. A pressure patch would retain chemical and delay definitive assessment.

Reference: Merck Manual Professional ocular-burn guidance: https://www.merckmanuals.com/en-ca/professional/injuries-poisoning/eye-trauma/ocular-burns