Household bleach is a common cleaning product containing sodium hypochlorite, typically in a concentration ranging from 3% to 8%. Ocular exposure to this substance is a serious chemical emergency. Bleach is highly alkaline (high pH), making it particularly dangerous to the delicate tissues of the eye. This chemical burn can quickly lead to severe and potentially permanent damage, making rapid intervention essential for preserving vision.
Immediate Emergency First Aid
The most important step after getting bleach in the eye is to begin copious irrigation with clean water immediately. Do not delay this action to search for saline solution or contact emergency services; every second the bleach remains in contact increases the risk of damage. The goal is to dilute and wash away the chemical quickly.
Use clean, cool, or lukewarm running tap water, and flush the affected eye for a minimum of 15 to 20 minutes. A shower is an effective way to ensure a constant, gentle stream of water over the eye. Alternatively, use a faucet by tilting your head and letting the water run over the bridge of your nose and into the eye. Hold the eyelid open with your fingers to ensure the water reaches all surfaces of the eye, including the conjunctiva under the lids.
If you are wearing contact lenses, remove them during the flushing process, or as soon as possible after starting irrigation, as the lenses can trap the chemical against the eye’s surface. Tilt your head so the water runs away from the unaffected eye to prevent cross-contamination. After the full 15 to 20 minutes of flushing, you must seek urgent medical attention, even if the eye feels better.
The Chemical Mechanism of Injury
Bleach is an alkali substance, registering high on the pH scale, often around 11 to 12. This high alkalinity makes the injury severe compared to an acid burn. While acids tend to cause protein coagulation that creates a protective barrier, alkali substances penetrate the eye tissue more rapidly and deeply.
The alkali reacts with fatty acids in the cell membranes of the cornea and conjunctiva in a process called saponification. This causes liquefaction necrosis, allowing the chemical to pass through the corneal layers and into the anterior chamber of the eye in as little as 5 to 15 minutes. Deep penetration can damage internal structures, including the iris, ciliary body, and lens, leading to inflammation and further tissue destruction. Irreversible damage can occur when the pH of the ocular surface rises above 11.5.
Professional Medical Evaluation and Prognosis
After the initial 15- to 20-minute irrigation, immediate evaluation by a medical professional, such as an ophthalmologist or emergency room physician, is required. The medical team will continue irrigation, often using sterile saline solution, until the eye’s pH level is normalized to a range between 7.0 and 7.2. This normalization is typically confirmed using pH testing strips.
The doctor will perform a comprehensive eye examination to determine the severity of the burn. They may use a fluorescein dye, which stains damaged areas, to check for corneal abrasions or epithelial defects. Treatment is based on the grade of injury and may include topical antibiotic drops or ointments to prevent infection and promote epithelial healing. For more significant inflammation, steroid drops may be prescribed, though these are carefully managed due to risks associated with prolonged use.
The final prognosis depends heavily on the concentration of the bleach, the duration of contact before irrigation began, and the thoroughness of the initial flushing. Mild burns may result in temporary irritation and a full recovery within a few days. Severe chemical burns can lead to serious complications such as corneal scarring, glaucoma, chronic dry eye, and permanent vision loss due to the destruction of limbal stem cells.