In ocular chemical burns, the Roper-Hall classification grade IV injury is defined by which corneal and limbal findings?

• A Corneal epithelial erosion only; no limbal ischaemia
• B Hazy cornea with iris details visible; < 1/3 limbal ischaemia
• C Stromal haze with iris details obscured; 1/3–1/2 limbal ischaemia
• D Total corneal opacity; > 1/2 limbal ischaemia ✓

Explanation

Roper-Hall grades: Grade I — corneal epithelial damage, no limbal ischaemia, good prognosis; Grade II — corneal haze with iris details visible, < 1/3 limbal ischaemia, good prognosis; Grade III — total epithelial loss, corneal haze with iris obscured, 1/3–1/2 limbal ischaemia, guarded prognosis; Grade IV — opaque cornea, > 1/2 limbal ischaemia, very poor prognosis. Limbal ischaemia (blanching) indicates loss of limbal stem cells and is the most critical prognostic indicator.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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