How to Flush an Eye After a Chemical Splash

Why this matters

A corrosive chemical starts damaging the surface of the eye within seconds, and alkalis keep penetrating for as long as they are in contact. Nothing done at the hospital later makes up for water that did not reach the eye in the first half minute, or for flushing that stopped after one minute because the person said it felt better. Field crews handle exactly the products that cause the worst eye injuries: acid and caustic drain openers, pool acid and chlorine, coil cleaners, battery electrolyte, wet concrete.

This card is the procedure, following current American Red Cross first aid guidance, OSHA's corrosives requirement and the 15-minute flushing period the eyewash standard is built around. The steps run alongside one real case so the decisions show at the moment they are made. Reading it is not training; hands-on first aid certification is what makes a responder.

The case these steps follow

A pool technician and a trainee are lowering the pH at a backyard pool on a hot afternoon. The trainee is pouring muriatic acid, a hydrochloric acid solution, from a jug into a bucket of pool water. The jug glugs and splashes, and acid hits the right side of his face and right eye. He shouts and clamps the eye shut. It is 14:03. The truck carries a squeeze bottle of eyewash solution and a garden hose is coiled on the patio.

The procedure

1. Get water into the eye now, from whatever is closest. A plumbed or self-contained eyewash, a sink, a shower, a garden hose on a gentle flow, bottled water. Do not walk the person past a usable water source to reach a better one, and do not read the SDS (safety data sheet) first; read it while flushing. Reason: the first seconds decide how deep the chemical gets. What breaks if skipped: a careful search for the right equipment while the acid works.

In the case: The lead grabs the squeeze bottle and starts flushing the trainee's eye at about 14:03 and 20 seconds.

2. Hold the eyelids open. The person will clamp the eye shut against the pain; that is a reflex and they cannot override it. Use your thumb and finger to hold the upper and lower lids apart, and have them roll the eye up, down and side to side while the water runs. Reason: water poured on a closed eye rinses the lid, not the eye. What breaks if skipped: fifteen minutes of flushing that never reached the surface under the lids.

In the case: The trainee cannot keep the eye open. The lead holds the lids apart with his gloved fingers.

3. Flush from the inner corner outward, with the head tilted toward the injured side. Water should enter near the nose and run out past the ear, so the runoff carries the chemical away from the uninjured eye. If both eyes were hit, flush both, alternating or with a source that covers both. Use a gentle flow; a hard stream from a hose nozzle can injure the eye on its own. Reason: a splash rinsed into the other eye doubles the injury.

In the case: The bottle empties in well under a minute. That is what squeeze bottles do: they are meant to start flushing or to clean out a particle, not to sustain 15 minutes. The lead moves the trainee two steps to the garden hose, runs it for a few seconds onto the concrete until the water is no longer sun-hot, turns it to a soft trickle without the nozzle, and resumes flushing at about 14:04, tilting the trainee's head to the right.

4. Take out contact lenses once flushing is under way, if they come out easily. After the first few minutes, ask whether they wear contacts. If a lens is in and slides out without effort, take it out, because chemical can be trapped behind it. If it does not come out easily, leave it and keep flushing; the hospital will remove it. Reason: a lens holds chemical against the eye, but stopping the flush to fight one costs more than it saves.

In the case: The trainee wears soft lenses. Around 14:07 the lead pinches the right lens and it comes out.

5. Keep flushing for 15 minutes, timed, and longer if the SDS says so. Fifteen minutes is the duration the emergency eyewash standard, ANSI/ISEA Z358.1, is designed to deliver, and it is the common first-aid minimum. For alkalis, which include drain openers, many coil cleaners, wet concrete and some pool chemicals, the SDS frequently calls for longer, and flushing should continue until a medical provider takes over. Use a phone timer. Reason: the person will say it feels better within a minute or two, which is the pain easing, not the chemical gone. What breaks if skipped: a person who stops at two minutes and still has acid in the folds of the conjunctiva, the lining under the lids.

In the case: At 14:06 the trainee says it is better and tries to pull away. The lead keeps him under the water. While flushing, the lead has him hold the hose so he can pull up the acid's SDS on his phone with his free hand: section 4 calls for at least 15 minutes and medical attention. Flushing on the hose started at about 14:04, so it runs to 14:19.

6. Send someone to call, or call on speaker, while you flush. For a corrosive in the eye, the call can be 911 or a drive to the emergency department after the full flush, and the deciding questions are whether the person can be safely driven and whether flushing can continue on the way. Call 911 when vision is badly affected, the person is in severe pain, the chemical is a strong alkali, both eyes are involved, or no one can drive while another flushes. Reason: emergency care for a chemical eye injury starts with more irrigation and a pH check, and the earlier it starts the better. See related: Calling 911 From a Job Site So They Find You.

In the case: It is only the two of them, and the trainee can see from his left eye. The lead decides to finish the full flush, then drive, rather than call an ambulance to a pool deck.

7. After flushing, protect the eye and take the chemical's identity along. Cover the injured eye loosely with a clean pad if it helps with light sensitivity; do not press on it and do not put drops or ointment in it. Bring the product container, a photo of its label, or the SDS. Reason: the ER will choose treatment by what the chemical was and may test the eye's pH to decide whether to keep irrigating. What breaks if skipped: a doctor told "pool stuff".

In the case: At 14:19 the lead stops the hose, puts a clean gauze pad loosely over the right eye, photographs the acid jug's label, and drives. At the ER he says "hydrochloric acid splash to the right eye, flushed 15 minutes with tap water, soft contact lens removed at about four minutes". They check the pH and irrigate further.

When the eye is hit by something other than a liquid

Dust, sand, sawdust and loose particles. Do not rub; rubbing drags a particle across the cornea. Flush with clean water or saline, the way steps 2 and 3 describe, until the particle is out. If it does not come out, or the eye still feels like something is in it after flushing, cover it loosely and see a clinician the same day. A particle that is stuck to or in the eye is not removed in the field with a swab, tweezers or a corner of cloth.

Grinding and cutting debris. A metal fragment from a grinder or a cutoff wheel can be hot enough to embed in the cornea and leaves a rust ring within hours. Anyone who felt something hit the eye while grinding, drilling metal or using a cutoff tool goes to a clinician the same day, even if it feels fine, because an embedded fragment often does.

An object stuck in the eye. This one reverses the rest of the card:

• Do not remove it, do not flush the eye, and do not press on it.
• Steady it: place a paper cup, or a ring of rolled gauze, over the eye around the object without touching it, and tape it in place.
• Cover both eyes, the injured eye under the cup and the other with a pad. The eyes move together, so as long as the good eye looks around, the injured one moves with it around the object.
• Call 911, keep the person still and calm, and do not let them walk alone, since both eyes are now covered.

When a splash does not need the emergency department

A splash of a mild irritant, such as dilute soapy water or a household cleaner that is not labeled corrosive, flushed for the full 15 minutes, with no pain, redness or blurred vision remaining afterwards, can be watched and reported rather than taken to the ER. If any symptom persists or returns, or the product's SDS section 2 lists it as corrosive or causing serious eye damage, the person sees a clinician the same day, regardless of how the eye feels.

What the case changed afterwards

The squeeze bottle bought less than a minute. On a pool deck with a hose it worked out, because the hose was two steps away; on a roof, a crawlspace or a yard without a spigot, there would have been nothing to switch to. Because pool acid and chlorine are corrosive, OSHA's first-aid rules (29 CFR 1910.151(c), and 29 CFR 1926.50(g) in construction) require suitable flushing facilities within the work area, which the shop then met with a self-contained eyewash station on each truck, mounted where it can be reached in seconds from the tailgate. See related: What OSHA Requires for First Aid at a Small Shop; How to Set Up and Maintain an Eyewash That Meets the Standard.

References

• American Red Cross, current first aid guidance on chemical eye injuries and embedded objects.
• ANSI/ISEA Z358.1, emergency eyewash and shower equipment, for the 15-minute flushing duration and tepid fluid.
• 29 CFR 1910.151(c) and 29 CFR 1926.50(g), flushing facilities where corrosives are used.
• The product's safety data sheet, sections 2 and 4, for corrosivity and flushing instructions.
• See related: Burns: Thermal, Chemical, and Electrical; Refrigerant and Cold Contact Burns.