Acute Ocular Chemical Injuries: Epidemiology, Clinical Profile And Management In A Portuguese Tertiary Eye Emergency Unit (2022–2025)

Acute ocular chemical injuries (AOCI) account for a significant proportion of visits to eye emergency departments worldwide. These ophthalmic emergencies range from mild epithelial defects to severe ocular surface destruction, potentially resulting in corneal opacification, limbal stem cell deficiency, secondary glaucoma and, in extreme cases, globe loss. Injury severity depends on the chemical substance involved, volume and duration of exposure and intrinsic toxicity, with alkali burns typically causing deeper tissue damage. Immediate irrigation remains the key determinant of visual prognosis. This study aimed to characterize the incidence, demographic profile, severity distribution and management patterns of AOCI.

Single-centre retrospective observational descriptive study conducted at the Ophthalmology Emergency Department of Centro Hospitalar Universitário de São João, a tertiary referral center in Porto, Portugal.

Medical records of patients presenting with AOCI to the Ophthalmology Emergency Department between 1 January 2022 and 31 December 2025 were reviewed. During this period, 53,440 patients attended the emergency unit, of whom 745 presented with AOCI (1.4%). A total of 861 eyes were included. Collected variables included age, sex, laterality, injury context, chemical agent, time to presentation, pre-hospital irrigation, clinical severity, management and complications. Corneal involvement and limbal ischemia were graded according to the Roper-Hall classification. Patient-level variables were analyzed per individual, while clinical severity and treatment variables were analyzed per eye.

A total of 745 patients (861 eyes) were included, 15.4% had bilateral involvement and 51.4% were female. Mean age was 44.1 years (range 18–89; SD 14.8). Most injuries were domestic (60.9%) or occupational (38.3%); assault was rare (0.7%). 84.4% of patients presented within 24 hours and 69.9% performed pre-hospital irrigation, with increasing rates between 2022 and 2024. Most eyes were Roper-Hall grade I (72.9%), followed by grade II (9.2%), grade III (1.7%) and grade IV (0.3%). Grade IV cases (two eyes, one patient) followed wet cement exposure and required admission with amniotic membrane transplantation. Most cases were managed conservatively with antibiotics (94.2%), corticosteroids (88.7%), lubricants (85.8%) and vitamin A (12.9%).

AOCI represent a substantial proportion of ophthalmic emergency visits, predominantly resulting from domestic and occupational exposure. Increasing irrigation rates between 2022 and 2024 may reflect improved public awareness and could contribute to favorable outcomes. The Roper-Hall grading system remains a valuable prognostic tool. While most injuries are mild and respond well to conservative therapy, severe alkali burns remain vision-threatening and require urgent specialized management.