New York State Medical Treatment Guidelines for Chemical Burns in workers compensation patients

The guidelines provided by the New York State Workers Compensation Board offer general principles for addressing chemical burns. These directives aim to assist healthcare professionals in determining appropriate strategies for diagnosing and managing injuries resulting from exposure to harmful chemicals as part of a comprehensive care plan.

Healthcare practitioners specializing in chemical burns can rely on the guidance from the Workers Compensation Board to make well-informed decisions about the most suitable approaches for assessing and treating injuries caused by chemical exposure in their patients.

It is crucial to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding the management of chemical burns should involve collaboration between the patient and their healthcare provider.

Chemical Burns

Most of the time, when your eyes get burned at work by chemicals, it’s usually because you’ve come into contact with either alkaline stuff like lime or sodium hydroxide, or acidic substances. But, it can also happen with petrochemicals and some other things. The type of chemical, how much of it there is, how strong it is, and how long you’re exposed to it—all of these factors play a big role in figuring out how bad the injury is going to be. Taking quick action right at the start is probably the most important thing to do. If you handle it fast, it can really make a difference in how well things turn out later on.



Right off the bat, it’s crucial to flush the eye with a whole bunch of water or some other watery solution—this is thought to be super important for giving the patient better and more successful treatment. Certain studies even hint that letting the flushing go on for a longer time can lead to better results, but as soon as the flushing is done, it’s important to get a healthcare pro in the mix to check things out.


Copious Irrigation for Chemical Eye Exposures

Here’s the advice for dealing with chemical eye exposures: For any kind of chemical exposure or eye injury, it’s a good call to kick off the eye rinse right after the exposure happens, instead of waiting for any symptoms to pop up. It’s also a smart move to start the rinsing process promptly while others try to figure out the details like what chemical it was, how strong it is, and how long the eyes were exposed. Keep up with the eye wash until you can get your hands on a Morgan lens if things are more serious.


Frequency/Dose/Duration: In the ideal industrial setup, hitting up an eye wash station should be the go-to move. If that’s not an option, regular tap water works fine, especially in on-site situations. Medical departments within the workplace, clinical areas, and some chemical labs also keep handy irrigation bottles with solutions. While normal saline or lactated Ringer’s solution is a step up from tap water, it’s only worth using if it’s on hand right away. Swap them in for tap water when possible.

For a smoother ride through the eye rinse, it’s a good call to use a topical anesthetic if you’ve got one. It helps the eye handle the rinse better.

Indications for Discontinuation: Only wrap up the intense flushing, usually after using at least 1-2 liters to clear out the chemical. Check for a balanced pH—aim for 7.0-7.2—for both acidic and alkaline exposures. After you’ve stopped the rinse, double-check the pH to make sure you’re all neutral and don’t need more flushing.

Rationale: When it comes to studies, there’s not much out there that compares using irrigation to not using it. We do have some experiments done with irrigating solutions, especially in animal models. Those studies hint that balanced salt solutions, like normal saline or lactated Ringer’s solution, work better than hypotonic ones, like tap water. But based on what we know from practice, it seems like the smart move is to start rinsing early with whatever solution is easiest to get, even if it’s just tap water. As you keep rinsing, you can customize the process, maybe even bring in a fancy irrigating system like the “Morgan lens.”


Chemical Burns

Irrigating Systems (e.g., Morgan Lens) for Chemical Eye Exposures

Recommended: When it comes to high-volume exposures or those with seriously acidic or alkaline risks, it’s a smart move to bring in irrigating systems. Don’t waste time setting up the system—start rinsing the eyes right after exposure, using the copious irrigation method we talked about earlier. And keep the irrigation going while you’re getting the system set up.

Frequency/Dose/Duration: The go-to solution for the rinse is a balanced salt one, like normal saline (0.9%) or lactated Ringer’s solution. For most chemicals, pump in 500 mL at a fast rate (let it run ‘open’). Take a breather, reassess, and think about adding more fluid based on the specific chemical, its concentration, how much got in, how long it’s been there, and how bad the effects are. If it’s an alkali burn, hit it with a full 2 liters at a wide-open rate, then slow it down to 50 mL/hr until the pH in the eye’s back corner is neutral. If you can’t get your hands on a balanced salt solution, tap water works as a temporary fix until you can or until you can shift to more permanent care.

Indications for Discontinuation: Only call it quits after you’ve thoroughly rinsed out the affected area. For both acid and alkaline exposures, make sure the pH is balanced between 7.0 and 7.2—it’s your green light to stop the rinse.

Artificial Tears or Lubrication : It’s a selective recommendation, meaning it’s suggested but not for everyone. If you’ve got a chemical ocular burn that’s sizable, painful, and especially if your tearing isn’t cutting it, consider using artificial tears or lubrication.

NSAID Ophthalmic Drops : Steer clear of using NSAID drops for treating chemical ocular burns. The evidence doesn’t support their use in this scenario.

Glucocorticosteroid Drops : These are recommended for moderate to severe chemical ocular burns. Here’s the catch—since they might increase pressure in your eye, only an eye specialist or a provider who can regularly keep tabs on eye pressure should prescribe them.

Eye Patching for Chemical Ocular Burns :

Recommended – Selectively for Treatment of Chemical Ocular Burns: This is a suggestion but not a one-size-fits-all solution. It’s recommended with some discretion for treating chemical ocular burns.

Indications: Go for it when you’re dealing with a chemical ocular burn that’s big enough to mess with your vision and not tearing up enough.


Surgical Interventions

In some instances, a small percentage of chemical exposures lead to lasting damage, such as scarring on the lens and, in extreme cases, blindness. Fortunately, surgical interventions, particularly corneal transplantation, can be effective for individuals experiencing corneal defects or scarring that impacts the visual axis.

Medical Contact Lens(es): It’s a thumbs-up for using medical contact lenses, but only in specific cases where there’s a lasting impact on vision, like when it’s worse than 20/40. This is the go-to move for those still dealing with decreased visual acuity, and the good news is, they’re usually well tolerated and carry fewer risks compared to transplant surgery.

Amniotic Membrane Transplantation (AMT): This one’s a selective recommendation for moderately severe chemical ocular burns. For select patients, amniotic membrane transplantation is the way to go. To tag along with this, you’ve got a medical therapy combo that includes prednisolone acetate, ofloxacin, sodium ascorbate, sodium citrate, lubricants, homatropine, and vitamin C for a specific duration.

Corneal Transplantation: When it comes to restoring vision, especially after being hit with blindness or corneal scarring post-chemical eye exposure, corneal transplantation is recommended. This is for cases where visual acuity is less than 20/40, and there’s a reasonable expectation that the retina is in good shape.

Hyperbaric Oxygenation: The recommendation here is a no-go for hyperbaric oxygenation.



Skip to content