The process of irrigation should proceed as follows:

• Explain to the patient what will take place. This is especially important in children who are scared and would not cooperate (see Chap. 2.16).

• Use anesthetics if necessary (see above).

• Carefully separate the lids. Placement of a lid retractor is preferred, although manual separation (see Chap 1.9) is also acceptable.

• Gently rinse the cornea and the fornices using an infusion line (Fig. 3.1.1); the infusion bottle should be 30-80 cm above eye level.

• Remove all particles" with a cotton-tipped applicator or forceps.

• Proceed with the irrigation even if the injury is open globe. Closure with sutures should follow, not precede, rinsing.

• Rinse the palpebral conjunctiva and the fornices as well; the latter requires double eversion (Fig. 3.1.2).

9 ANSI-Standard Z358.1-2004.

10 Prevor GmbH, Köln, Germany.

11 These are usually calciferous.

Fig. 3.1.1 Rinsing the eye after a chemical injury. The flow of the rinsing fluid is low and soft, the eye is turned away from the stream, the lids are held open with fingers pressuring the bones not the eyeball, and a paper drain is used to try to keep the patient's clothing dry
Fig. 3.1.2 Double eversion of the upper lid with a Desmarres retractor. The upper fornix is completely visible and accessible, making particle removal easy to perform. The patient is instructed to look straight downward, and his forehead is positioned low to permit free flow of the irrigation fluid

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