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Solutions for Difficult Problems: Eye Irrigation — Morgan Lens No More! Part 2

One of the lengthiest procedures in the emergency department can be eye irrigation. Some patients may need 5-15 liters of normal saline flush, which can take hours. Alkaline products need ample flushing and constant reevaluation with pH checks to avoid ocular burns. Patients can get frustrated and often times will ask you to stop the procedure. Keeping up with an eye irrigation patient can be difficult for providers as well, and create a long stay.

One of the best ways to irrigate the eye involves using IV saline via a nasal cannula and connector piece from a Salem Sump kit. This procedure is far less invasive than using the Morgan Lens and is less traumatic for the patient. Patients…

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 Trick of the trade: Eye irrigation setup

For the past several years, I’ve stopped using Morgan lens and have started using something that all Emergency Departments have — nasal cannulas for oxygen administration. They are perfect for high-volume eye irrigation. Instead of attaching the nasal cannula to an oxygen port, attach it to the end of IV tubing, which in turn is attached to a 1 liter normal saline bag. The IV tubing fits snuggly into the nasal cannula tubing.

Articles of Interest

ToxCard: Caustic Eye Injuries

Prompt irrigation is the most important initial therapy, regardless of whether the caustic substance is acidic or alkali. Tetracaine ophthalmic drops are safe to use in chemical injuries and will increase the tolerability (and therefore the effectiveness) of the irrigation. Oral pain and anxiety treatment may also be necessary.

Eye irrigation as a first-line treatment and diagnostic method for emergency department patients who complain of ocular foreign bodies

In the present prospective cohort study, we determined that external eye irrigation significantly reduced ocular pain and the probability of a retained corneal FB in patients visiting EDs with complaints of ocular FBs. In addition, if a patient’s subjective ocular pain greatly diminished after irrigation, the likelihood of a retained FB was very low.

Eye irrigation is more comfortable with a lidocaine: containing irrigation solution compared with normal saline

Continuous irrigation of the eye with a lidocaine-saline solution and a Morgan lens causes less discomfort than saline alone in healthy volunteers.

How to irrigate the eye

For severe acid or alkali burns, emergency irrigation should continue for at least 15 minutes; 30 minutes is better. It is advisable to continue to irrigate acid/alkali burn injuries for a further 12–24 hours by setting up a saline drip to continue to gently irrigate the eye.

Morgan Lens Insertion

Management of chemical burn to the eye with Morgan Lens Insertion.

Tips for Tots: Ocular Chemical Burns

You know that chemical burns, particularly alkaline burns, represent a true ophthalmologic emergency. You also recognize that immediate copious irrigation remains the single most important therapy for chemical ocular injuries. However, you are concerned that you will not be able to effectively examine and treat this distraught pediatric patient. Intranasal versed or fentanyl are quick, non-invasive, and effective options for anxiolysis and analgesia. Intranasal versed is dosed at 0.3 to 0.5 mg/kg.

Resources

The Morgan Lens

Unlike manual irrigation, it is not necessary to evert and swab under the eyelids since the Morgan Lens effectively removes any non-embedded foreign bodies or particulate matter trapped in these regions. In addition, when the eyelids are open or retracted, folds are formed which may trap chemicals, but this problem is also eliminated by the Morgan Lens.