Pa r t
8 Chemical-induced ocular
side effects
Devin Gattey, MD
Class: Acids
Generic name: 1. Hydrofluoric acid; 2. hydrochloric acid;
3. sulfuric acid.
Synonyms: 1. Fluoric acid, fluohydric acid, hydrofluoride,
fluorine monohydride; 2. hydrogen chloride, muriatic acid;
3. battery acid, sulfuric acid, hydrogen sulfate, sulfine acid.
Proprietary names/products containing: 1. Eagle
One Chrome and Wire Cleaner, Ultradent Porcelain Etch,
FPPF Acid Enhanced Trailer Brightener, Whink Rust Remover,
Arrobrite Aluminum Brightener, Briter 601 Glass Cleaner;
2. Lysol Brand ­Toilet Bowl Cleaner, Humidifier Plastic Cleaner,
Febreze Laundry Odor Eliminator, Lime A Way Toilet Bowl
Cleaner, Zep Grout Cleaner and Whitener, Zep Calcium, Lime,
and Rust Stain Remover, C Flux (Lead Free) maintenance paste,
Kem Tek Calcium & Metal Eliminator, Kem Tek Tile & Spa
Cleaner, Parks Muriatic Acid 20%.; 3. Rain Away Rain Repel-
lent, Naval Jelly Rust Dissolver, Loctite Sink Jelly, Goddards
Silver Dip, Instant Power Liquid Drain Opener, Duro Alumi-
num Jelly Corrosion Remover, pH Down, pH Adjust
Primary use
Hydrofluoric acid
This compound is used to clean and etch glass and metal in
the manufacture of silicone wafers and in the synthesis of many
fluorine-containing organic compounds, including teflon and
­refrigerants such as freon. It is also used in many household
rust removers.
Hydrochloric acid
Sold as muriatic acid, this is used for a variety of household,
scientific research and construction purposes. Hydrochloric acid
is also used to clean and electroplate metal, and to tan leather. It
is used to adjust pH in many products.
Sulfuric acid
A principal component in the manufacture of batteries, this
is also used in the fertilizer, petroleum refining and printing
­industries as well as in metal cleaning and electroplating and in
the paper industry.
Ocular side effects
Direct ocular exposure
Certain
1. Ocular irritation
a. Eye pain
2. Lacrimation
3. Non-specific blepharospasm
4. Conjunctiva
a. Hyperemia
b. Edema
c. Blanching of vascular bed
d. Symblepharon
5. Cornea
a. Edema
b. Scarring
c. Ulceration
d. Vascularization
e. Perforation
f . Fibrovascular pannus
6. Entropion
7. Iritis
Possible
1. Cataracts
2. Increased intraocular pressure
Clinical significance
In general, acids are less injurious to the eye than alkalis. As is
the case for alkalis, concentration, time and surface area of ex-
posure, and pH are the factors which most influence the extent
of the injury. Once the pH drops to 2.5 or below the ­extent of
injury is likely to be much more severe. Hydrofluoric, hydrochlo-
ric and sulfuric acids can all cause extensive corrosive damage,
initially from the high concentration of hydrogen ions. How­ever,
hydrofluoric acid is considered the acid most likely to cause
­severe ocular and skin injuries.
Most acids cause a coagulative necrosis of the corneal epithelium,
which helps to prevent penetration of the acid into the deeper layers
of the cornea or the anterior chamber. With hydrofluoric acid, the
fluoride ion itself can penetrate the cornea and cause severe dam-
age. In fact, the ability of the free fluoride ion to penetrate tissue
and combine with internal body calcium stores makes splash expo-
sures potentially fatal. Hypocalcemia may ensue in cases where less
than 10% of the body surface area has been exposed to hydrofluoric
acid, causing cardiac arrhythmia and bone damage.
The ocular injury pattern for hydrofluoric and other concentrat-
ed acids is very similar to that for alkalis. A higher concentration
and longer exposure time may be needed to achieve the same de-
gree of injury, but the same types of injury are possible, including
corneal and conjunctival scarring, and symblepharon formation.
Recommendations
The most important intervention in ocular exposure to concen-
trated acids is immediate irrigation. Many studies have been
done to identify the optimal irrigating solution for various types
of chemical exposure, but the subtle advantages of one solution
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