A construction worker sustains a chemical splash to both eyes from cement (calcium hydroxide — pH 12.5). Immediate first aid at the site was delayed by 20 minutes. On examination, conjunctival pallor (blanching), limbal ischemia of 4 clock hours, corneal haze, and markedly elevated IOP of 42 mmHg are noted. According to Roper-Hall classification, this injury is grade:
- A Grade I
- B Grade II
- C Grade III ✓
- D Grade IV
Explanation
Roper-Hall classification of chemical burns grades severity based on limbal ischemia and corneal clarity: Grade I — corneal epithelial damage only, no ischemia; Grade II — corneal haze but iris visible, <1/3 limbal ischemia; Grade III — total corneal epithelial loss, stromal haze (iris difficult to see), 1/3–1/2 limbal ischemia; Grade IV — opaque cornea (iris not visible), >1/2 limbal ischemia. Limbal ischemia of 4 clock hours equals 1/3 of the circumference with corneal haze — this fits Grade III. IOP elevation is from chemical damage to trabecular meshwork, a recognized acute complication.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.