Eye irrigation for patients with ocular chemical burns: a systematic review

Aim The aim of this systematic review is to present the best available research evidence on eye irrigation methods for ocular chemical burns. Inclusion criteria Randomized, quasi‐randomized controlled trials and observational studies comparing the effectiveness of methods of eye irrigation among adults or children as an active form of emergency treatment for ocular chemical burns were considered for review. Studies were eligible for inclusion if methods of eye irrigation were examined within the following comparison categories: time to commence first eye irrigation; types, volumes, durations, flow rates and temperature of eye irrigating fluids; and comfort measures during eye irrigation. The types of outcome measures include immediate ocular outcomes and complications, clinical outcomes, self‐reported outcomes, length of hospital stay and working days lost. Search strategy Electronic bibliographic databases in English and Chinese were searched from inception to June 2010 and yield 8,999 citations. Other sources were searched by hand to identify studies or additional relevant source materials. The reference lists and bibliographies of all articles retrieved were scrutinized to identify further studies and added a further 22 articles. A forward search on the authors of the studies identified was also performed. Methodological quality A study eligibility verification form was developed for the assessment and two reviewers made independent decisions on whether to include each publication in the systematic review. Critical appraisals of study quality were undertaken independently by two reviewers using the Joanna Briggs Institute critical appraisal tools. Any disagreement that arose between the two reviewers was resolved by discussion. Data extraction Data extraction was performed by one reviewer using a data extraction form developed for the systematic review. Another reviewer checked for accuracy. Data synthesis Given the clinical and methodological diversity among the studies included in this review, the review findings are presented in a narrative form and no meta‐analysis has been performed. Results and discussion A total of four studies involving 302 adults and children with ocular chemical burns met the inclusion criteria for the systematic review. One study determined the effects of prompt irrigation of the eyes with tap water immediately after alkali burns had been suffered at the scene of injury. The authors report that patients who underwent immediate irrigation had significantly better clinical and ocular outcomes. One study compared four ocular irrigation fluids administered in an emergency department and found more patients preferred a modified saline (balanced saline solution plus) than other type of irrigation fluids. Another study compare the effectiveness of two ocular irrigation fluids in hospital setting reported that for patients with grade 1 and 2 burns, the time elapsed to re‐epithelialization was shorter in the group rinsing with diphoterine when compared with the group rinsing with normal saline. The results in another study demonstrated that patients with ocular chemical burns treated with prolonged irrigation reported shorter duration of treatment at the hospital and absence from work. However, the results should be treated with caution, as there were significant differences between the comparison groups in some studies, and incomplete details on methods of random assignment and a small sample size were issues of concern. Conclusions There is insufficient evidence to determine the optimal eye irrigation methods to improve ocular and clinical outcomes. Randomized trials using sample sizes with adequate power are needed to compare the clinical benefits of eye irrigation methods and further trials should take into account the potentially important factors such as the time to commence eye irrigation and cumulative effects of irrigating fluids that might affect the outcomes and adopt strategies to deal with them. Implications for practice Currently there is insufficient evidence to inform practice of eye irrigation among adults or children as an active form of emergency treatment for ocular chemical burns. Healthcare professionals need to continuously update themselves about the latest evidence on the optimal methods of eye irrigation in enhancing patient outcomes. Implications for research More well designed randomized and quasi‐experimental trials with adequate sample size are needed to further examine the effective methods of eye irrigation for ocular chemical burns. Future studies should provide sufficient information about the demographic and clinical data including the types and severity of ocular injuries, causative chemicals, first‐aid management, and time elapsed to eye irrigation. Furthermore, a clear description of the eye irrigation protocol is crucial to facilitate comparisons across studies. Potential conflict of interests The authors of this systematic review do not have any type of conflict of interest.