Getting household bleach in your eye is a serious medical emergency that requires immediate action. Household bleach is an alkaline solution, typically containing sodium hypochlorite, which can cause rapid damage to the delicate tissues of the eye. The severity of the injury relates directly to the chemical concentration, the duration of exposure, and how quickly first aid is administered. Because of its high pH, bleach penetrates the ocular surface quickly, meaning permanent vision impairment can occur within minutes if treatment is delayed.
Immediate Steps and Emergency Flushing
Immediate and continuous irrigation of the eye with clean water or saline is the most important step after bleach exposure. Do not waste time looking for neutralizing solutions or specialized eyewash stations; the priority is to dilute and wash away the corrosive chemical immediately. The goal of this emergency flushing is to quickly return the eye’s surface pH to its normal, neutral level.
Flush the affected eye for a minimum of 15 to 20 minutes, even if the pain subsides earlier. Use lukewarm water to avoid discomfort; a gentle, steady stream is better than a hard jet. Hold the eye open with your fingers to ensure the water reaches all parts of the eye and the undersides of the eyelids.
If you wear contact lenses, remove them immediately during flushing, as they trap the chemical against the eye’s surface. Tilt your head so the affected eye is down and to the side, allowing water to flow away from the face and prevent contamination of the other eye or skin. After the full 15 to 20 minutes of flushing, seek professional medical attention right away, even if the eye appears fine. Call Poison Control or emergency services while flushing, or immediately after, to receive guidance for transfer to a medical facility.
The Chemical Injury Mechanism
Bleach is harmful because it is an alkali with a high pH, often around 12, which is significantly more severe than an acid injury. Alkalis are lipophilic, meaning they dissolve fats, allowing the caustic chemical to penetrate cell membranes easily and rapidly. This process, known as saponification of fatty acids, leads to the breakdown of tissue structure.
This destructive process is called liquefactive necrosis, characterized by tissue softening and dissolving, enabling the chemical to move deeper into the eye structure. The hydroxyl ions in the bleach denature the collagen matrix, facilitating further penetration into the anterior chamber in as little as 15 seconds. This deep penetration exposes internal structures, such as the lens, ciliary body, and the trabecular meshwork, to damage.
This mechanism explains why alkaline burns, like those from bleach, are generally more devastating than acid burns, which typically cause coagulation necrosis. Acid burns create a coagulated protein layer that acts as a protective barrier, limiting deeper penetration. Initial symptoms of bleach exposure, such as pain, redness, blurred vision, and eyelid twitching, are direct results of this rapid chemical destruction of the corneal and conjunctival tissues.
Professional Medical Care and Recovery
Once a patient arrives at a medical facility, the priority remains continued irrigation, often using specialized solutions, until the pH of the ocular surface is normalized. A healthcare professional will use special paper to test the pH of the eye surface to confirm the chemical has been neutralized. The medical team will then perform a thorough diagnostic evaluation, including assessing visual acuity and using a slit lamp microscope to examine the extent of damage to the cornea and conjunctiva.
Professional treatment focuses on minimizing inflammation, preventing infection, and promoting the healing of the ocular surface. This typically involves topical antibiotics to prevent secondary infection, and potentially steroids to control the inflammatory response. Medications to dilate the pupil, called cycloplegics, may also be prescribed to reduce pain from muscle spasms and prevent internal scarring.
The long-term prognosis relates directly to the initial severity of the burn, particularly the degree of damage to the limbus, which contains the stem cells necessary for corneal regeneration. Severe burns can lead to complications, including corneal scarring, which causes clouding and loss of vision, and glaucoma, which results from damage to the eye’s internal drainage system. In the most severe cases, extensive scarring, cataracts, and permanent vision loss can occur, requiring surgical procedures like corneal transplants or limbal stem cell transplantation years later.