1. Elisabeth CA Macdonald, Paul A Cauchi, Augusto Azuara-Blanco, Barny Foot Authors have no financial interest BOSU

2.  Chemical injuries to the eye represent one of the true emergencies in ophthalmology  They may require extended medical care and result in longterm ocular morbidity  Public health and occupational health strategies have attempted to reduce the rate of these  The true incidence of these in the UK and subsequent demand on medical services was unknown  This study aimed to estimate the national incidence of severe chemical corneal injuries in the UK BOSU

3.  Prospective population based study  Performed with British Ophthalmological Surveillance Unit (BOSU) monthly reporting system Run by the RCOphth, UK BOSU

4.  Monthly report card with case definition sent to all consultant or associate specialist ophthalmologists with clinical autonomy in the UK  Respondents indicate how many cases they have seen that month  Investigators are notified of positive reports  Reporting ophthalmologist is contacted using a questionnaire to collect information regarding case BOSU

5.  12 month study period Dec 2005- Nov 2006  Report of any severe chemical corneal injury  Def.- an injury with all of the following: 1. Total loss of the corneal epithelium 2. Corneal haziness obscuring iris detail or worse 3. Over 120 o of limbal ischaemia Grade 3 or 4 on the Hughes-Roper-Hall scale BOSU

6.  Monthly card return rate 78%  Twelve cases were identified  Min. estimated incidence in the UK of severe chemical corneal injury of 0.02 per 100 000  66.7% of injuries were in males of working age (16-65yrs)  Min. estimated incidence in the UK of severe chemical corneal injury in males of working age of 0.04 per 100 000 BOSU

7.  75% occurred in males  Mean age at time of injury was 33.8 yrs Range 10–59 yrs  50% occurred at work  33.3% resulted from assault BOSU

8.  Alkali was causative in 66.7%  Only one patient was wearing eye protection at the time of injury  75% received immediate irrigation BOSU

10.  Six patients required 1 or more surgical procedures Amniotic membrane graft was the most common surgical procedure  At 6 months follow-up BCVA 6/12 or better in 5 patients 6/60 or worse in 2 patients BOSU

12.  The incidence of severe chemical corneal injury in the UK is low  The cases that occur can require extended hospital treatment, with substantial ocular morbidity and visual sequelae  Current enforcement of eye protection in the workplace in the UK has probably contributed to a reduced incidence of severe ocular burns BOSU