A 22-year-old student was accidentally splashed with a strong alkaline solution (NaOH). At 30 minutes post-injury, there is complete corneal opacification, obliteration of limbal vessels with white chemosis (perilimbal ischaemia), and the anterior chamber is not visible. This injury is classified as:
- A Roper-Hall Grade II
- B Roper-Hall Grade III
- C Roper-Hall Grade IV ✓
- D Roper-Hall Grade I
Correct answer: C. Roper-Hall Grade IV
Explanation
The Roper-Hall classification grades chemical injuries by corneal clarity and limbal ischaemia: Grade I = corneal epithelial damage only, no limbal ischaemia (prognosis excellent); Grade II = corneal haze with visible iris detail, less than one-third limbal ischaemia; Grade III = total corneal epithelial loss, stromal haze obscuring iris/pupil, one-third to half limbal ischaemia; Grade IV = total corneal opacification with opaque stroma (anterior chamber invisible), more than half limbal ischaemia (prognosis grave). Complete opacification + total limbal ischaemia = Grade IV.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.