How are chemical burns to the eye graded?

Updated: Oct 08, 2019
  • Author: Mark Ventocilla, OD, FAAO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Injuries can be graded from 0-5, as follows:

  • Grade 0 - Minimal epithelial defect, clear corneal stroma, no limbal ischemia

  • Grade 1 - Partial-complete epithelial defect, clear corneal stroma, no limbal ischemia, corneal epithelial involvement only

  • Grade 2 - Partial-complete epithelial defect, mild stromal haze, none or only mild limbal ischemia

  • Grade 3 - Complete epithelial defect, moderate stromal haze, less than one third of the limbus is ischemic

  • Grade 4 - Complete epithelial defect, stromal haze blurring iris details, one third to two thirds of the limbus is ischemic

  • Grade 5 - Complete epithelial defect, stromal opacification, greater than two thirds of the limbus is ischemic

Grades 0-2 can be expected to heal well with proper care and follow-up examinations.

The course for grades 3-5 is more tenuous and may require surgical intervention, in the form of either limbal stem cell transplantation to regenerate the ocular surface or penetrating keratoplasty to replace the corneal stroma and endothelium. These cases have a much poorer prognosis.

Higher-grade injuries are more susceptible to secondary complications.


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