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    Cornea/External Disease

    This paper reports the incidence, nature, outcomes and complications of severe ocular chemical injuries observed in an emergency room during a 7-month period.

    Study design

    This prospective, consecutive, interventional study included 98 patients (110 eyes) who presented with ocular chemical injuries at a U.K. eye emergency department. Patient treatments included irrigation, topical treatment and amniotic membrane transplantation, based on severity and clinical signs.

    Researchers noted the nature, outcomes, complications and incidence of the injuries as well as limbal stem cell deficiency (LSCD). Two different classifications of chemical eye injuries—Roper-Hall (RH) and Dua—were also compared.


    The estimated incidence of acute chemical eye injuries was 5.6 per 100,000. Most patients were male (60.2%), had unilateral injuries (87.8%) and presented on the same day of injury (80.6%). The average age at presentation was 36.5 years (range 1–78). Overall, 52.1% injuries were work related and 41.8% were domestic. Alkali was the most common causative chemical agent (78.6%). Almost all the eyes were managed with topical nonsurgical treatment (96.4%).

    Both the RH and Dua grading systems classified the majority of injuries as mild to moderate (grade I or II). The most severe cases (RH grade IV, Dua grade IV-VI) all developed total LSCD and exhibited poor visual outcomes (BCVA 6/60 to hand movement). Of the 4 RH grade IV cases, the 2 that were classified as Dua grade VI had worse final vision compared with the 2 Dua grade IV.


    There is a broad spectrum of presentations for chemical eye injuries and grading systems do not always correctly reflect the extent of damage or accurately predict visual outcomes. There was a low number of patients with severe chemical eye injuries, making it difficult to assess which grading system more effectively predicted outcomes.

    Clinical significance

    Young male patients in the working age group are most prone to work-related chemical eye injuries. Between the 2 grading classifications studied, the Dua system seems to have better prognostic value in the most severe cases because it considers both conjunctival and corneal injury. Topical treatment of most mild to moderate injuries result in favorable clinical outcomes.