Chemical injury to the eye is classified using the Roper-Hall classification. A Grade IV injury (worst) is defined by which findings?

• A Corneal haze obscuring iris details with one-third to one-half limbal ischemia
• B Corneal stromal edema with intact limbus
• C Total corneal epithelial loss with more than half of limbus ischemia ✓
• D Superficial conjunctival hyperemia with fluorescein-staining corneal epithelial defects

Explanation

The Roper-Hall classification of chemical ocular injuries grades severity by corneal clarity and limbal ischemia: Grade I (good prognosis) — corneal epithelial damage only, no limbal ischemia; Grade II — hazy cornea with iris detail visible, <1/3 limbal ischemia; Grade III — total epithelial loss, stromal haze obscuring iris, 1/3–1/2 limbal ischemia; Grade IV (very poor prognosis) — opaque cornea completely obscuring iris and pupil, >1/2 limbal ischemia. Grade IV indicates extensive limbal stem cell destruction, requiring stem cell transplantation (keratolimbal allograft) as eventual surgical rehabilitation.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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