A 25-year-old construction worker presents with a chemical splash to the right eye. Vision is hand movements. Slit-lamp shows total corneal opacification with a white avascular limbal zone of 360°. The grade of chemical burn (Roper-Hall classification) and immediate treatment priority are:
- A Grade II (Dua B) — antibiotics and cycloplegics immediately
- B Grade IV (Roper-Hall) — immediate and copious irrigation for 30 minutes before any other assessment ✓
- C Grade III — refer to tertiary center without initial treatment
- D Grade IV — patch the eye and arrange limbal stem cell transplant urgently
Explanation
Total corneal opacification with 360° perilimbal ischemia represents Roper-Hall Grade IV (Dua Grade V/VI) chemical burn — the most severe grade with the worst prognosis. The absolute first priority in any chemical eye injury is IMMEDIATE copious irrigation (saline, Ringer's lactate, or even tap water) for a minimum of 30 minutes, aiming to restore normal conjunctival pH (7.0–7.4), before any other examination or treatment. Delay in irrigation worsens penetration and tissue destruction, particularly with alkali (continues to penetrate). Assessment and other treatments follow irrigation.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.