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A potential deficiency in current chemical injury classification system

Poster Details

First Author: R.Jain INDIA

Co Author(s):    N. Mohan                    

Abstract Details


To enumerate difference between grades of severe chemical injury and elucidate role of tenonplasty in cases with scleral ischemia


drishtiCONE eye care - Jain Eye Hospital and LASER Centre, AG-152, Shalimar Bagh, Delhi-110088


Current ocular chemical injury grading system doesn’t include Scleral ischemia as a separate entity and puts cases with limbal ischemia with/without scleral ischemia in same category. Case 1: 22 year man presented with alkali injury with 360 limbal ischemia and ground glass cornea. He was advised amniotic membrane transplantation which he refused. At 3 months, he presented with total limbal stem cell deficiency. Case 2: 23 year man presented 1 month after alkali injury with round, 4 cm area of non-healing corneal epithelial defect and thinning adjacent to an area of scleral ischemia.


The difference in clinical presentation in case 1/2 post injury is due to the accompanying scleral ischemia in case 2. While case 1 healed with conjunctavalisation over cornea, presence of scleral ischemia in case 2 prevented conjunctivalisation and led to persistent non healing corneal defect and cornea melt. In acute stage management, while in case 1 amniotic membrane transplantation alone will suffice, case 2 requires additional tenonplasty and conjunctivoplasty which was performed. Scleral ischemia gradually vascularised. Corneal epithelial defect healed with conjunctivalisation. The patient awaits definitive surgery for visual rehabilitation 6 months later.


We highlight the difference in management of severe ocular surface injuries with scleral ischemia and describe a potential deficiency in current chemical injury classification system.

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