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Review Article | DOI: https://doi.org/10.31579/2690-4861/971
1Hiba Basher Mohamed, MD. Specialist Ophthalmologist, University of Khartoum, Khartoum–Sudan. Primary Health Care Corporation (PHCC)–Doha, Qatar.
2Eltahir Ahmed Eltahir1 MD, Assistant Professor of Surgery, University of AL Fashir– Darfur- AL Fashir-Sudan. Kampala International University (KIU)- Western Campus - Bushenyi-Uganda, https://orcid.org/0000-0001-9992-0322.
3Moneer Ali Abdallah, Associate Professor, Faculty of Medicine, Al Neelain University, Khartoum -Sudan 4. Kampala International University (KIU)- Western Campus - Bushenyi, Uganda https://orcid.org/0000-0001-5880-7382.
4Muna Mohammed Ahmed Hamid Ahmed5, Assistant Professor of Ophthalmology, University of AL Fashir, AL Fashir – Darfur- Sudan. Kampala International University (KIU), Western Campus - Bushenyi, Uganda, https://orcid.org/0009-0003-4301-2781.
*Corresponding Author: Eltahir Ahmed Eltahir MD, Assistant Professor of Surgery, University of AL Fashir– Darfur- AL Fashir-Sudan. Kampala International University (KIU)- Western Campus - Bushenyi-Uganda.
Citation: Mohamed Basher HB, Eltahir A. Eltahir, Moneer A. Abdallah, Ahmed Hamid MM, (2025), Corneal Ulcer due to a Grade 1 Chemical burn Managed Successfully with Combined Tobramycin 3% and Dexamethasone 1% eye drops: A Case Report and Review of the Literature, International Journal of Clinical Case Reports and Reviews, 30(4); DOI:10.31579/2690-4861/971
Copyright: © 2025, Eltahir Ahmed Eltahir. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 12 September 2025 | Accepted: 22 September 2025 | Published: 02 October 2025
Keywords: grade 1 ocular chemical burn; central corneal ulcer; combined dexamethasone and tobramycin eye drops
Chemical cornea injury is a true ocular emergency and requires immediate intervention. Diagnoses rely on clinical assessment and classification. Treatment is directed to improve the epithelial integrity and stromal stability, reduce undue inflammation and prevent or timely manage complications.
Case presentation: A 45-year-old male presented with chemical injury to his left eye from a painting agent. He was classified as Grade 1 ocular surface chemical burn with a large central corneal ulcer and spared limbal area and conjunctiva, treated successfully with the administration of combined dexamethasone and tobramycin eye drops to the standard treatment starting from the second day, with complete healing after 5 days.
Conclusion: Grade 1 ocular surface chemical burn with a large central corneal ulcer can be treated successfully with combined dexamethasone and tobramycin eye drops.
Chemical injuries to the eye represent between 11.5% and 22.1% of ocular traumas. About two-thirds of these injuries occur in young men and children aged 1 -2 years are particularly at risk. Most injuries occur in the workplace as a result of industrial accidents. Alkaline materials are commonly found in building materials and cleaning agents. It occurs more frequently than acid injuries and is more harmful than Acids. [1]
Chemical injuries to the cornea and conjunctiva are a true emergency and require immediate intervention because they can lead to extensive damage, leading to permanent visual impairment and disfigurement. The severity of the ocular injuries depends on four factors:
1- Toxicity of the chemical.
2- Duration of contact with the eye.
3- Depth of penetration.
4- Area of involvement.
Irrigation is the cornerstone of managing chemical burns, and it should be initiated according to established standards, continuing throughout the transfer of the patient between the EMS, ED physician, and the ophthalmologist. Irrigation aims to remove the offending substance and restore physiological pH levels. Suggested guidelines recommend that irrigation should continue for a minimum of 30 minutes, using 1-3 litres of fluid, or until the physiological pH is reached. [2]
The physical examination should be used to assess the extent and depth of the ocular injury. Two major classification schemes for ocular chemical burns are the Roper–Hall (modified Hughs) and Dua classifications. The Roper–Hall classification is based on the degree of corneal and conjunctival involvement and limbal ischemia [6] 3. The Dua classification is based on an estimated limbal involvement (in clock hours) and the percentage of the conjunctival involvement. [4] Patient with mild to moderate injuries (Grades 1 and 2) has a good prognosis with medical therapy aiming to enhance corneal epithelial integrity and stromal stability, reduction of undue inflammation and prevention and timely management of complications. Steroid eye drops can help to calm the inflammation and prevent further corneal breakdown, with the caution of maintaining the balance between collagen synthesis and collagen breakdown. [5]
A forty-five-year-old Sri Lankan male presented to the ophthalmology clinic in PHCC with a history of chemical injury to his left eye by the entrance of a painting substance during his work five hours before his presentation. Irrigation to the left eye started in the emergency department and continued in the ophthalmology clinic for 30 minutes with about two litres of normal saline solution, following the installation of topical anaesthetic eye drops and the patient was advised to blink frequently. The patient complained of blurred vision, a foreign body sensation, tearing, and mild swelling of the upper eyelid of his left eye. There was no complaint in the right eye, and no history of systemic illness. On physical examination, the best corrected visual acuity (BCVA) in the right eye was 6/6, and in the left eye 6/9, with no improvement with pinhole. Slit lamp examination showed the right eye was normal for both the anterior and posterior segments. The left eye exhibited mild diffuse oedema of the upper lid, conjunctival hyperemia with ciliary congestion, and examination of the fornices for any material. There was a central large superficial corneal ulcer (with fluorescein uptake) covering about three-quarters of the corneal surface, with epithelial cell condensation at the peripheral ulcer margin and free limbal involvement (Figure 1).
Figure 1: Patient presented with a left eye central corneal ulcer with a free limbal area as shown by fluorescein staining
This corresponds to a Grade 1 chemical ocular injury according to the Roper-Hall classification. The anterior chamber was clear, with no cells detected; intraocular pressure was normal on digital assessment, and fundus examination was slightly hazy but showed a normal optic nerve and central retina. The treatment commenced with the protocol of antibiotics, mydriatics and lubrication. 0.5% Moxifloxacin eye drops applied four times a day, Cyclopentolate eye drops three times a day, and preservative-free lubricants five times daily on the first day. On the second day of follow-up, there was no improvement in the patient's symptoms or visual acuity; the conjunctival hyperemia persisted, and the corneal ulcer remained unchanged in size. The anterior segment examination did not reveal any differences from the day one examination. These findings are against the expected prognosis for this grade 1 chemical burn with the ordinary treatment used (antibiotics, mydriatics and lubrication), with expected improvement after 24 hours. Also, no clinical signs of secondary microbial contamination and the presentation of the patient is a direct case of chemical injury in normal eye, so no need for corneal scraping for smear and culture. I decided to start inflammation control by steroid; the recommended steroid is prednisolone eye drops. But I decided to use dexamethasone eye drops so that I need a more superficial potent effect with less penetration to the corneal layers. This is my unique treatment approach to start directly with dexamethasone rather than prednisolone acetate eye drops. I started adding combined tobramycin 3Percent dexamethasone 1Percent eye drops with QID frequency to
concentrate on the superficial corneal inflammation control due to low penetration of the dexamethasone rather than prednisolone, which has more corneal penetration so mostly effective in deep inflammation control, with continuation of the same previous medications. Combination of dexamethasone with tobramycin as antibiotic for more antimicrobial prophylaxis approach with moxifloxacin to protect the injured corneal from secondary bacterial infections. On the third day of follow-up, the patient reported improvement in symptoms, lid swelling decreased, the conjunctiva was less hyperemic, and the corneal ulcer started to reduce in size for about ½ of the corneal surface. The intraocular pressure, checked with non-contact tonometry, was 11 and 12 in the right and left eye, respectively. The pupil was dilated pharmacologically to 5 mm. The patient continued on the same treatment plan. On the sixth day of follow-up, the symptoms have resolved completely, the corrected visual acuity is 6/6 for both eyes, the conjunctiva was quiet, the corneal ulcer completely healed with mild scattered punctate epithelial erosions with faint fluorescein uptake, the pupil is dilated pharmacologically to 5 mm. I planned to stop the antibiotic and cyclopentolate eye drops and start steroid tapering to TID Follow up after 5 days, the patient was asymptomatic with corrected visual acuity of 6/6 in both eyes, clear cornea, no fluorescein uptake, IOP was 11 and 12 for right and left eye, respectively. Planned to complete the tapering of dexamethasone eye drops every 5 days and continue on lubricants. Figure [2] Follow-up after 3 months, both eyes were normal with 6/6 BCVA and IOP, clear cornea in both eyes and normal anterior and posterior segments in both eyes.
Figure 2: Complete healing of the central corneal ulcer after treatment on day 11 with no fluorescein stain uptake
Chemical injury to the cornea is a true ocular emergency and requires immediate interventions and close follow-up. Alkaline injury is more harmful to the cornea due to its rapid tissue penetration, and it causes more tissue damage. Our patient reported within 5 hours after injury with an Alkali substance (painting agent) with mild vision loss, pain, redness and tearing. After frequent irrigation, the patient was diagnosed as grade 1 ocular injury with a large central corneal ulcer and free limbal area, The patient was planned to be treated with antibiotics, cycloplegics and lubricants, but without improvement on the second day. The addition of combined tobramycin 3% and dexamethasone 1% eye drops leads to patient recovery within 3 days. Our novelty and contribution in this case is based on the immediate decision of early intervention for controlling the corneal inflammation response to the chemical injury on the second day, if no signs of early improvement within 24 hours of ordinary treatment with antibiotics, mydriatics and lubrication. On the other hand, the selection of dexamethasone as a steroid is superior to prednisolone acetate eye drops for its potent effect in inflammation control with less penetration into the corneal layer, so it is better for superficial corneal inflammation control. Combination of dexamethasone with tobramycin as antibiotic for more antimicrobial prophylaxis approach with moxifloxacin to protect the injured corneal from secondary bacterial infections. In a study by Huda et. al, the composition of active compounds in the Calotropis latex was analyzed with the help of phytochemical screening. It was found that the latex contains several alkaloids, which are poisonous. It was concluded that the stromal keratitis was due to inflammation triggered by these toxins. The use of corticosteroids helps in the resolution of the keratitis and supports this theory. [6] In a study by Pandey and Sahu, 25% of the patients had epithelial defects, stromal oedema, and Descemet’s folds were persistent when steroid was withheld in patients with epithelial defects; they started to resolve once topical steroids were started. It was concluded that striate keratitis resolves with topical steroids. [7] In a case study by Apurva Prabhudesai et.al, Cureus 2024, chemical injury by Calotropis plant sap called latex, can affect the vision significantly if left untreated. Treatment with systemic antibiotics, topical steroids and lubricant drops immediately leads to recovery in a short period. [8] In our case, the patient was treated with topical steroids, antibiotics and cycloplegics, and he was completely recovered within 5 days. In a case study by Waikar and Srivastava, their patient was treated similarly and recovered in two days. Conjunctival staining and Descemet membrane folds persisted for two more days. [9]
This case highlights how the early treatment with a combination of dexamethasone and tobramycin eye drops, along with the standard treatment, can significantly enhance the healing of Grade 1 chemical burns with extensive corneal ulcers.
This case report concerns a single patient; therefore, the results cannot be generalized. Additionally, the study was conducted in a resource–limited setting at a primary care level, where the clinical image clarity is limited to using a mobile phone camera for documentation, as no slit-lamp fixed camera is available in our clinic. Also, certain investigations, such as ocular PH checking papers, are unavailable, along with specific interventions like Diphtheriae amphoteric solutions for irrigation to normalize the ocular pH and improve healing.
Conflict of interest:
The author declares no conflicts of interest
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and accompanying images.
A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
Ethical approval:
Ethical approval was obtained from the local ethical committee/research, PHCC, Qatar
Financial Support:
No funding was received for this study.
Research Registration:
Not applicable
Provenance and peer review:
The research was peer-reviewed and approved by the PHCC Institutional Review Board (IRB)
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Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
