Chemical conjunctivitis describes when chemicals enter and irritate part of the eye. Treatment involves flushing the eye and using topical steroids, but surgery may be necessary for severe irritation.

Conjunctivitis, also known as pink eye, is inflammation of the conjunctiva. This is the thin layer that covers and protects the whites of the eyes and the inside of the eyelid. Conjunctivitis can develop for several reasons, including bacterial and viral infections and allergies. One type is chemical conjunctivitis, which occurs after exposure to environmental irritants.

Chemical eye injuries can heal after early recognition, flushing, and management. However, severe chemical conjunctivitis can lead to vision problems and blindness. Recognizing and responding to chemical irritation in the eye is vital.

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Chemical conjunctivitis occurs when irritants, such as fumes, pollution, alkalis, and acids, enter the eye and cause inflammation on the surface.

According to a 2022 study, 7.3% to 22.1% of eye injuries occur due to chemical exposure. An older source notes that chemical conjunctivitis may be acute, in that treatment resolves it permanently. However, the irritation or inflammation may come back or become chronic, meaning it persists.

The cause of chemical conjunctivitis dictates how serious it is and how urgently a person requires treatment.

For example, people can develop chemical conjunctivitis irritation after exposure to air pollution, swimming pool cleaner, or noxious fumes. This would qualify as minor exposure, as it is unlikely to damage the layers below the conjunctiva.

Chemical injuries, however, are more serious. Health experts may categorize the causative agents as acids, alkalis, or irritants, such as alcohol. Alkalis and acids sit at opposite ends of the pH acidity scale. Both can harm the eyes, but alkalis are a more common cause of eye injuries. Some evidence suggests that alkalis account for two-thirds of chemical injuries to the eyes, and the remainder are from acids and alcohols.

Examples of substances that can lead to chemical conjunctivitis include the following:

TypeSubstanceWhat contains this
AcidAcetic acidVinegar
AcidHydrochloric acidSwimming pools
AcidHydrofluoric acidGlass polish and mineral refining fluids
AcidSulfuric acidCar batteries
AcidSulfurous acidRefrigerant and bleach
AlkaliAmmoniaFertilizers, cleaning agents, and refrigerants
AlkaliLimeWhite wash, mortar, plaster, and cement
AlkaliLyeAirbags and drain cleaners
AlkaliMagnesium hydroxideFlares and sparklers
AlkaliPotassium hydroxideCaustic potash

Many of these exposures can occur in work environments.

Flushing or irrigating the eye is vital for removing the chemical agent as quickly as possible. According to a 2020 paper, this can reduce the severity of conjunctivitis and improve visual outcomes.

For bystanders to flush the eye, the Centers for Disease Control and Prevention (CDC) recommends:

  1. The person flushing the eyes should wash their hands using soap. Alcohol-based hand sanitizer can cause further irritation.
  2. While holding the eyes open with the fingers or a tool, such as a speculum, wash the eyes with lots of water or a sterile, neutral solution for about 30 minutes.
  3. The person flushing the eyes should encourage the person receiving the flushing to blink often and look in all directions to ensure the agent is absent from the eye whites.
  4. Note the chemical involved, when the exposure occurred, and how it happened. Pass this information on to medical or paramedic staff when they arrive.

The American Academy of Ophthalmology (AAO) does not recommend using tap water, as this can cause the chemical agent to move deeper within the eye. However, if bystanders only have access to nontoxic tap water, they can use this. Rapidly removing the chemical agent from the eye is the most important factor to consider while waiting for medical treatment.

Careful flushing of the eyes with saline solution is a standard treatment for chemical conjunctivitis. A medical professional will likely continue the eye flushing. They might also apply anesthetic eye drops to reduce discomfort during this procedure.

Chemical conjunctivitis causes similar symptoms to other types of conjunctivitis, including:

  • redness
  • discharge
  • redness on the underside of the eyelids
  • eyelids sticking together upon waking up
  • unaffected vision

However, severe chemical eye irritation may cause complications, such as severe pain and potential loss of vision. Exposure to any chemicals that trigger this reaction warrants immediate medical attention. When chemicals do impact vision, health experts may refer to it as chemical keratitis.

Following any chemical exposure, a person should rinse their eyes. Mild chemical conjunctivitis, such as after exposure to air pollution, may only need lubricant eye drops and generally resolves after 24 hours.

However, after initially flushing, people with more severe chemical conjunctivitis may need further flushing in the doctor’s office. They may also receive prescriptions for different types of eye drops, including:

  • steroids to reduce inflammation and irritation, with more regular doses available for more severe injuries
  • antibiotics to prevent further infections on top of the injury
  • cycloplegic drops, which dilate the pupils and help the doctor assess damage

Surgery to remove dead eye tissue, restore the conjunctiva, replace stem cells that support eye healing, and reduce inflammation may be necessary for people with severe, chronic inflammation or vision loss.

Protective eye equipment can help protect the eyes from exposure to hazardous chemicals. The Occupational Safety and Health Administration (OSHA) regulation 29 CFR 1910.133(a)(1) requires employers to provide appropriate eye protection to employees who handle “liquid chemicals, acids or caustic liquids, chemical gases, or vapors.”

For milder chemical conjunctivitis, wearing swimming goggles can help protect the eyes from swimming pool water. Staying indoors during times of high air pollution, such as during wildfires, may also reduce the risk of health effects from unclean air.

Chemical conjunctivitis occurs when acids, alkalis, or other irritating substances enter the eye. This may cause inflammation in the conjunctiva, which can lead to redness, tearing, and discharge.

Some causes, such as swimming pool cleaner or air pollution, have mild effects. Others, including industrial materials and battery acid, require immediate flushing and medical attention.

Steroids and other eye drops may help reduce inflammation and improve comfort. Surgery is available to treat the most severe chemical conjunctivitis. Protective eye equipment or other methods for reducing exposure to the irritant can help prevent future chemical conjunctivitis instances.