Schrage et al used a simple classification for the emergency handling of chemical burns to the eye. It is a modification of the scheme used by Reim. The authors are from the Aachen Augenklinik, Germany.
Types of injuries:
(1) alkali (about two thirds)
(2) acids (about one quarter)
(3) thermal burns (hot metals, fireworks, etc.)
(4) miscellaneous chemical agents
Parameters:
(1) epithelial erosions
(2) conjunctiva
(3) limbal ischemia/damage
(4) corneal damage
Erosions |
Conjunctiva |
Limbal Ischemia |
Corneal Damage |
Grade |
absent |
normal |
none |
none |
0 |
present |
hyperemia |
1 - 33% |
superficial |
I |
present |
chemosis |
34 - 50% |
superficial |
II |
present |
chemosis |
51 - 75% |
opacified |
III |
present |
chemosis |
> 75% |
opacified with necrosis |
IV |
Grade |
Complications |
Prognosis |
0 |
none |
complete restitution |
I |
none |
complete restitution |
II |
may have focal scarring |
complete restitution with small scars |
III |
corneal damage, vascular proliferation |
scarring; may require ophthalmologic surgery |
IV |
corneal ulcers, iris atrophy, retinal complications, glaucoma, loss of globe, blindness, cosmetic deformity |
uncertain but may be poor, usually some degree of residual disability |
Immediate and continued irrigation is essential, pending ophthalmologic management. Delayed irrigation may be associated with more severe damage and a worse prognosis.
Specialty: Toxicology, Emergency Medicine, Critical Care, Ophthalmology
ICD-10: ,