In ocular chemical burns, what is the initial management step?

• A. Normal saline irrigation until pH is normal
• B. Visual acuity check and pH testing AFTER irrigation (1–2 L)
• C. Consult ophthalmology
• D. Apply antibiotic ointment immediately

Answer: (A)

Immediate, copious irrigation with normal saline or balanced salt solution is the first and most important step. The goal is to rapidly dilute and remove the chemical and to neutralize the ocular surface, continuing irrigation while monitoring the surface pH until it is in the normal range (about 7.0–7.4). This early action prevents ongoing tissue injury and improves outcomes. After irrigation starts, you can proceed with assessment and further management, including ophthalmology consultation; topical antibiotics or analgesia can be added as needed, but they do not replace the initial irrigation.