Editorial Ocular trauma, an evolving sub specialty
Most of us commonly see patients with ocular trauma in our daily practice. This may range from a small foreign body on the cornea to a ruptured globe, from a patient presenting with 6/6 vision to a patient with no perception of light. All these patients get treated differently depending upon the part of the country and availability of medical support. All of us have different levels of involvement in treating them. There have been numerous individual reports on ocular trauma. WHO has reported 55 million eye injuries causing restriction of daily activities, of which 1.6 million go blind every day.[1] Vats et al., have reported the prevalence of ocular trauma to be 2.4% of population in an urban city in India. 11.4% of these are blind.[2] In this issue there is an interesting article by Agarwal et al., on visual outcomes in patients with posterior open globe injury. The other aspects that need attention include terminology and classification of ocular trauma [Figs 1 and 2]. Among the standard systems available, Birmingham Eye Trauma Terminology is the one most widely accepted.[3] There have also been numerous controversies with respect to classification. There have been classifications approved by International Society of Ocular Trauma, but these are limited to globe injuries and do not include injury to the orbit or adnexa.[3] The classification proposed by Dr Shukla, which is approved by the Ocular Trauma Society of India (OTSI), is a comprehensive classification. In spite of these numerous articles on ocular trauma, we still do not have any estimate of the actual prevalence of ocular trauma in India. The American Society of Ocular Trauma has a United States Eye Injury Registry and the International Society of Ocular Trauma has a World Eye Injury Registry. The Ocular Trauma Society of India has proposed an India Eye Injury Registry for the same. A registry would enable us to measure epidemiology, standardize and evaluation protocols, data collection for treatment outcomes, propose clinical trials, and disseminate information. Term
Definition Interpretation
Explanation
Eyewall
Sclera and cornea
Though technically the eyewall has three coats posterior to the limbus, for clinical and practical purposes, violation of Only the most external structure is taken into consideration
Closed globe injury Open globe injury Contusion
No full-thickness wound of eyewall Full-thickness wound of the eyewall No (full-thickness) wound
Lamellar laceration Rupture
Partial-thickness wound of the eyewall Full-thickness wound of the eyewall caused by a blunt object.
The wound of the eyewall is not “through” but” into” Because the eye is filled with incompressible liquid, the impact result in momentary increase of the Intraocular pressure. The eyewall yields at its weakest point (at the impact site or elsewhere; eg,an old cataract Wound dehisces even though the impact occurred elsewhere: The actual wound is produced by an inside-out mechanism.
Laceration
Full thickness wound of the eyewall caused by a sharp object
The wound occurs at the impact site by an outside-in mechanism.
Penetrating injury
Entrance Wound
If more than one wound is present, each must have been caused by a different agent. Technically this is a penetrating injury but grouped separately because of different clinical implications.
Retained Foreign object(s) Perforating injury
Entrance and exit wounds
The injury results from direct energy delivery by the Object (eg, choroidal rupture) or from the changes in The shape of the globe (eg, angle recession).
Both wounds are caused by the same agent.
Some injuries remain difficult to classify (an intravitreal BB pellet). Technically an intraocular foreign body (IOFB) Injury is a blunt object that requires great force to enter the eyes, involving an element of rupture. In such situations, the Ophthalmologist should describe the injury as “mixed” (ie, rupture with an IOFB) or select the most serious type of the mechanisms involved.
540
Figure 1: Present classification of Ocular trauma
Indian Journal of Ophthalmology
Vol. 61 No. 10
Figure 2: General classification of Ocular trauma
I would like to once again emphasis on the changing perspectives in ocular trauma and look at ocular trauma as an evolving separate sub-specialty.
Sundaram Natarajan
References
Editor, Indian Journal of Ophthalmology, Chairman, Managing Director, Aditya Jyot Eye Hospital Pvt Ltd, Wadala (W), Mumbai, Maharashtra, India. E-mail: editor@ijo.in
1. Ngrel AD, Thylefors B. The global impact of eye injuries [J]. Ophthalmic Epidemiol 1998;5:143-69. 2. Vats S, Murthy GV, Chandra M, Gupta SK, Vashist P, Gogoi M. Epidemiological study of ocular trauma in an urban slum population in Delhi, India. Indian J Ophthalmol 2008;56:313-6. 3. Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): Terminology and classification of mechanical eye injuries. Ophthalmol Clin N Am 2002;15:139-43. Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.121063 PMID: ******
Copyright of Indian Journal of Ophthalmology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Most of us commonly see patients with ocular trauma in our daily practice. This may range from a small foreign body on the cornea to a ruptured globe, from a patient presenting with 6/6 vision to a patient with no perception of light. All these patients get treated differently depending upon the part of the country and availability of medical support. All of us have different levels of involvement in treating them. There have been numerous individual reports on ocular trauma. WHO has reported 55 million eye injuries causing restriction of daily activities, of which 1.6 million go blind every day.[1] Vats et al., have reported the prevalence of ocular trauma to be 2.4% of population in an urban city in India. 11.4% of these are blind.[2] In this issue there is an interesting article by Agarwal et al., on visual outcomes in patients with posterior open globe injury. The other aspects that need attention include terminology and classification of ocular trauma [Figs 1 and 2]. Among the standard systems available, Birmingham Eye Trauma Terminology is the one most widely accepted.[3] There have also been numerous controversies with respect to classification. There have been classifications approved by International Society of Ocular Trauma, but these are limited to globe injuries and do not include injury to the orbit or adnexa.[3] The classification proposed by Dr Shukla, which is approved by the Ocular Trauma Society of India (OTSI), is a comprehensive classification. In spite of these numerous articles on ocular trauma, we still do not have any estimate of the actual prevalence of ocular trauma in India. The American Society of Ocular Trauma has a United States Eye Injury Registry and the International Society of Ocular Trauma has a World Eye Injury Registry. The Ocular Trauma Society of India has proposed an India Eye Injury Registry for the same. A registry would enable us to measure epidemiology, standardize and evaluation protocols, data collection for treatment outcomes, propose clinical trials, and disseminate information. Term
Definition Interpretation
Explanation
Eyewall
Sclera and cornea
Though technically the eyewall has three coats posterior to the limbus, for clinical and practical purposes, violation of Only the most external structure is taken into consideration
Closed globe injury Open globe injury Contusion
No full-thickness wound of eyewall Full-thickness wound of the eyewall No (full-thickness) wound
Lamellar laceration Rupture
Partial-thickness wound of the eyewall Full-thickness wound of the eyewall caused by a blunt object.
The wound of the eyewall is not “through” but” into” Because the eye is filled with incompressible liquid, the impact result in momentary increase of the Intraocular pressure. The eyewall yields at its weakest point (at the impact site or elsewhere; eg,an old cataract Wound dehisces even though the impact occurred elsewhere: The actual wound is produced by an inside-out mechanism.
Laceration
Full thickness wound of the eyewall caused by a sharp object
The wound occurs at the impact site by an outside-in mechanism.
Penetrating injury
Entrance Wound
If more than one wound is present, each must have been caused by a different agent. Technically this is a penetrating injury but grouped separately because of different clinical implications.
Retained Foreign object(s) Perforating injury
Entrance and exit wounds
The injury results from direct energy delivery by the Object (eg, choroidal rupture) or from the changes in The shape of the globe (eg, angle recession).
Both wounds are caused by the same agent.
Some injuries remain difficult to classify (an intravitreal BB pellet). Technically an intraocular foreign body (IOFB) Injury is a blunt object that requires great force to enter the eyes, involving an element of rupture. In such situations, the Ophthalmologist should describe the injury as “mixed” (ie, rupture with an IOFB) or select the most serious type of the mechanisms involved.
540
Figure 1: Present classification of Ocular trauma
Indian Journal of Ophthalmology
Vol. 61 No. 10
Figure 2: General classification of Ocular trauma
I would like to once again emphasis on the changing perspectives in ocular trauma and look at ocular trauma as an evolving separate sub-specialty.
Sundaram Natarajan
References
Editor, Indian Journal of Ophthalmology, Chairman, Managing Director, Aditya Jyot Eye Hospital Pvt Ltd, Wadala (W), Mumbai, Maharashtra, India. E-mail: editor@ijo.in
1. Ngrel AD, Thylefors B. The global impact of eye injuries [J]. Ophthalmic Epidemiol 1998;5:143-69. 2. Vats S, Murthy GV, Chandra M, Gupta SK, Vashist P, Gogoi M. Epidemiological study of ocular trauma in an urban slum population in Delhi, India. Indian J Ophthalmol 2008;56:313-6. 3. Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): Terminology and classification of mechanical eye injuries. Ophthalmol Clin N Am 2002;15:139-43. Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.121063 PMID: ******
Copyright of Indian Journal of Ophthalmology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
