A patient presents with a corneal alkali burn. The Roper-Hall grading system is used to classify the severity. Grade III chemical injury is defined by which finding?

• A Corneal haze with obscured iris details, limbal ischemia between one-third and one-half ✓
• B Corneal haze with visible iris details, limbal ischemia less than one-third
• C Corneal epithelial damage only, no ischemia
• D Cornea opaque with obscured iris and pupil, limbal ischemia greater than one-half

Explanation

Roper-Hall Grade III shows corneal haze obscuring iris details with limbal ischemia of one-third to one-half. Grade I has epithelial damage only. Grade II has corneal haze with visible iris details and ischemia less than one-third. Grade IV has opaque cornea with ischemia greater than one-half. The Dua classification has largely replaced Roper-Hall in recent use.

Reference: AAO BCSC Section 8: External Disease and Cornea, 2022-2023 ed.

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