Ocular Irrigant Alternatives in Pediatric Emergency Medicine

Author: Saidinejad, Mohsen MD; Burns, Michele M. MD

Journal: Pediatric Emergency Care. 21 (1):23-26, January 2005

Abstract: Minimizing pain and discomfort in an important consideration in pediatric ocular decontamination. The pH of an irrigant solution plays a significant role in its tolerability, because a solution with a pH that is too low or too high may cause edema and discomfort to the conjunctiva. We reviewed several available ocular irrigation solutions with respect to their chemical composition, pH and cost efficiency.

Currently, the irrigation solution of first choice for most ocular decontaminations in the pediatric emergency department (ED) is 0.9% saline solution for normal saline (NS), which has a pH range between 4.5 and 6.0. Alternative ocular irrigant solutions available include Lactated Ringers solution (LR), which has a pH range between 6.2 and 7.5, buffered NS with pH adjusted to 7.4 with sodium bicarbonate, and Balanced Salt Solution Plus (BSS Plus), which has a pH of 7.4. Of these alternative solutions, all except BSS Plus are comparable in cost efficiency to NS. The use of more pH neutral solutions such as LR, NS with bicarbonate buffer, or BSS Plus may decrease ocular pain and irritation associated with copious irrigation, and may improve tolerance of ocular decontamination by a child.

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Three Army soldiers were on their way to us following an explosion of an improvised device. The driver had goggles on and suffered extensive facial trauma and all three had eye injuries from the debris that hit them. We got bilateral Morgan Lenses in all three and flushed each with several liters of LR. Followed with antibiotics, they were rebandaged and on an emergency air evacuation that evening. These men were grateful for the care they received. The technicians and physicians here are thankful that everyone knew what to do to get the lens system set up and running. I am grateful to you for the opportunity to access the class online and ability to present it shortly after we arrived. One of the others did have a corneal laceration that we could assess after flushing. We feel confident that all will have the best outcomes thanks to the Morgan Lens use.

We also had a patient who experienced an electrical explosion (a generator) to his face. We used Morgan Lenses to irrigate his eyes and sent him on an air evacuation flight to Germany. He has since returned to duty and is doing well with minimal residual sight loss.

Military Registered Nurse (Active Duty)

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Why Use The Morgan Lens?

The Morgan Lens is used in 90% of hospital emergency departments in the USA and can be inserted in less than 20 seconds. There simply is no other "hands-free" method of eye irrigation. Nothing else frees medical personnel to treat other injuries or to transport the patient while irrigation is underway. Nothing is more effective at treating ocular chemical, thermal, and actinic burns or removing non-embedded foreign bodies, even when the patient's eyes are closed tightly. Its design makes it simple and straightforward to use so minimal training is required.

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