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. 2001 Nov;85(11):1379-83.
doi: 10.1136/bjo.85.11.1379.

A new classification of ocular surface burns

H S Dua  1 , A J King, A Joseph
Affiliations

A new classification of ocular surface burns

H S Dua et al. Br J Ophthalmol. 2001 Nov.
No abstract available

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Figures

Figure 1
Figure 1
Grade 1 ocular surface burn. Large corneal burn following accidental exposure to ammonia. There is no limbal or conjunctival involvement. Fluorescein stained diffuse view of the cornea.
Figure 2
Figure 2
(A) Grade 3 (4.5/30%) ocular surface burn. Four and a half clock hours of limbus involvement with 30% conjunctival involvement following ocular surface burn with a domestic cleansing (alkali) injury. (B) and (C) the surviving limbal epithelium demonstrates circumferential migration of tongue-shaped projections affording limbal epithelial cover to denuded limbus. (D) The entire limbus has healed with limbal epithelium and the corneal surface too is almost completely healed with corneal (limbal derived) epithelium. The conjunctival defect is closing with conjunctival epithelium. Fluorescein stained diffuse view of the cornea.
Figure 3
Figure 3
Grade 3 (5/35%) ocular surface burn following an accident involving an industrial alkaline chemical. Five clock hours of the limbus and 35% of the conjunctiva were involved. (A) Diffuse view with patient looking straight illustrating the extent of limbal involvement. (B) Diffuse view with patient looking up and out and (C) looking up and in to show the extent of conjunctival involvement. (With the Roper Hall grading (III) this would carry a guarded prognosis. This patient made a complete recovery.)
Figure 4
Figure 4
Grade 4 (7/50%) ocular surface burn following an acid burn. Seven clock hours of the limbus and 50% of the conjunctiva were involved. (A) An autolimbal transplant was first carried out in the inferior nasal quadrant (arrows). (B) One year after a full thickness corneal transplant that succeeded the autolimbal transplant by 4 months. Arrows show the limits of the autologous conjunctiva attached to the peripheral corneal strip that constituted the "autolimbal graft." The patient has been followed for 2.5 years and retains a clear graft. (With the Roper Hall grading (IV) this would carry a poor prognosis.)
Figure 5
Figure 5
Grade 5 (9.5/60%) ocular surface burn following alkali injury. Nine and a half clock hours of the limbus and 60% of the conjunctiva were involved. (A) Diffuse view of the cornea showing extensive conjunctivalisation and a fibrovascular pannus. (B) The eye 13 months after ocular surface reconstruction with autolimbal transplantation. (With the Roper Hall grading (IV) this would carry a poor prognosis.)
Figure 6
Figure 6
Grade 6 (12/100%) ocular surface burn with a "fish pond cleaning liquid" following an assault. The entire limbus and the entire conjunctiva were involved. (A) Diffuse view showing involvement of the entire upper and (B) lower bulbar conjunctiva. (C) The entire corneal surface and 12 clock hours of the limbus are involved. This patient carries a very poor prognosis.
Figure 7
Figure 7
Grade 6 (12/100%) ocular surface burn following injury with cement powder. The entire limbus and conjunctiva were involved. This picture was taken 7 months after the injury. The eye is becoming pthysical with extensive symblepharon. This illustrates the very poor prognosis of a grade 6 burn. (With the Roper Hall grading Figs 4, 5, 6, and 7 would all be grouped under grade IV with a poor prognosis.)
See this image and copyright information in PMC

Comment in

  • Modification of classification of ocular chemical injuries.
    Harun S, Srinivasan S, Hollingworth K, Batterbury M, Kaye S. Harun S, et al. Br J Ophthalmol. 2004 Oct;88(10):1353-4; author reply 1354-5. doi: 10.1136/bjo.2004.046797/047308. Br J Ophthalmol. 2004. PMID: 15377570 Free PMC article. No abstract available.

References

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