A 22-year-old chemistry student splashes acid from a battery into his right eye. On examination, there is corneal haziness but the limbal vessels are visible. According to the Roper-Hall classification, this represents which grade and what is the prognosis?

• A Grade I — no limbal ischemia; good prognosis
• B Grade II — limbal ischemia less than one-third; good prognosis ✓
• C Grade III — limbal ischemia one-third to one-half; guarded prognosis
• D Grade IV — total limbal ischemia; poor prognosis

Explanation

The Roper-Hall classification grades chemical burns by corneal haze and limbal ischemia: Grade I = clear cornea, no limbal ischemia (good prognosis); Grade II = corneal haze with visible iris details, less than one-third limbal ischemia (good prognosis); Grade III = total corneal epithelial loss with hazy cornea obscuring iris details, one-third to one-half limbal ischemia (guarded prognosis); Grade IV = opaque cornea, greater than one-half limbal ischemia (poor prognosis). Visible iris details with corneal haziness and visible limbal vessels corresponds to Grade II. The IMMEDIATE treatment priority for ANY chemical burn is copious irrigation before detailed examination.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.