Table 4.

Acute medical treatment of severe ocular chemical burns

Medical Treatment	Key aimsa	Suggested choices or dose
Broad-spectrum topical antibiotics	Prophylaxis against infection in presence of epithelial defects.	Topical PF fluoroquinolones or chloramphenicol four times a day
Potent steroid eye drops	Reduce inflammation and proteolytic enzyme release, preventing uveitis and stromal melting.	Topical PF dexamethasone 0.1% or prednisolone acetate 1%, 1–2 hourly
Potassium ascorbate 10% eye drops	Co-factor for collagen synthesis (needed for corneal stromal healing), protecting against corneal ulceration and perforation	1–2 hourly
Oral ascorbic acid	As above	1 g twice a day
Sodium citrate 10.11% eye drops	Chelation of cations and preventing release of proteolytic enzymes, preventing corneal melts/perforation.	1–2 hourly
Oral tetracycline	Suppressing proteolytic enzymes and scavenging free oxygen radicals release. Halting corneal epithelial and stromal melts.	Doxycycline 100 mg once daily, or oxytetracycline 500 mg twice a day
Cycloplegic eye drop	Mydriasis and pain relief	Topical PF cyclopentolate 1%, 2–3 times a day
Lubricating eye drops (PF)	Prevents drying and promotes re-epithelialisation	Locally available PF eye drops, 1–2 hourly
IOP lowering therapy	Control raised intraocular pressure	Treatment choice depends on level of ocular hypertension. Early consultation with glaucoma team advised.

PF preservative-free

^aSee references in respective sections below