In chemical eye injuries, the Roper-Hall classification (grade IV) is characterized by which combination of features?

• A Corneal epithelial defect only with no limbal ischaemia
• B Total corneal opacification with no iris details and limbal ischaemia > 1/2 ✓
• C Hazy cornea with iris details visible and limbal ischaemia < 1/3
• D Corneal haze with iris visible and limbal ischaemia 1/3 to 1/2

Explanation

Roper-Hall Grade IV chemical injury is the most severe: total corneal opacification (no iris or pupil details visible) with more than 50% limbal ischaemia (blanching) indicating massive stem cell destruction and poor prognosis for corneal re-epithelialization. Grade I has epithelial damage only; Grade II has hazy cornea with visible iris and <1/3 limbal ischaemia; Grade III has totally hazy cornea with no iris details and 1/3–1/2 limbal ischaemia. Alkali burns penetrate deeper and faster than acid burns, causing more severe damage.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.