Cement Ocular Injury Leading To Isolated Corneal Endothelial Dysfunction: A Case Series Of A Rare Entity

To present a rare and severe complication of cement eye injury, isolated endothelial injury, of a Roper-Hall 1/Dua 1 grade ocular chemical injury (the lowest injury grade). Thus, this rare complication represents a gap between the favorable prognosis of the injury determined by the present available grading systems to the actual injury severity.  

Rabin Medical Center, a tertiary medical center in Israel

Four patients presented to our institute following cement injury to their eye. In all, limbal area was only mildly affected, epithelium healed rapidly and there was no stromal involvement. At their initial visit, they were all diagnosed with a Roper-Hall 1/Dua 1 chemical injury indicating a mild injury with favorable prognosis. However, surprisingly during their follow up appointments, diffuse corneal edema with Descemet's folds was observed, indicating an endothelial dysfunction. The treatment was modified accordingly by elevating topical steroid dosing and adding hypertonic saline drops, slowly leading to a full recovery with corneal clearing. Nevertheless, endothelial cell loss (compared to the unaffected eye) was observed by specular microscopy later on.  

Isolated endothelial dysfunction after ocular chemical injury, without severe involvement of other corneal tissues, is a rare but serious complication of the initial chemical injury. In this case series, this complication was unique to cement injury. We believe that the available grading systems (Roper-Hall/Dua) does not fully address this entity - which should not be graded as a mild injury as the available grading systems suggests. Thus, a modification to the present grading systems is warranted.