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The ocular trauma score (OTS)
Abstract
Only based on a standardized terminology of ocular trauma terms, and using a very large number of injuries treated by a wide variety of ophthalmologists, could a reliable method be developed so that the functional outcome of a serious eye injury can be predicted with reasonable certainty. The authors used the databases of the United States and Hungarian Eye Injury Registries and, with a grant from the National Center for Injury Prevention at the Centers for Disease Control and Prevention, designed such a system.
... [7] Ocular trauma score (OTS) was developed as a set of standard language that is a worldwide, exact communication system as well as a system for identifying, quantifying, and predicting mechanical injuries. [8] The OTS method predicts the final visual acuity (VA) based on the baseline VA, relative afferent pupillary defect (RAPD), globe rupture, endophthalmitis, a perforating injury, and retinal detachment (Table 1). Despite its widespread use and validation in several studies and across age groups, it might be challenging to assess VA and RAPD, two major OTS criteria, in children, especially in post-traumatic situations. ...
... The ocular trauma score variables and raw points for calculating the ocular trauma score(Kuhn et al. 2002) ...
Background:
The aim of this study is to assess the relationship between computed tomography (CT) findings in open globe injuries (OGIs) in pediatric patients and the pediatric ocular trauma score (POTS) and OTS in pediatric ocular trauma.
Methods:
In 34 pediatric patients with OGI, CT findings were categorized into nine main categories: Scleral irregularity, lens dislocation, abnormal vitreous density, choroid-retinal layer thickening, preseptal thickness increase, intraocular foreign body and air, vitreous hemorrhage, retinal detachment, and perforation. The relationship between different types and numbers of CT findings and the POTS and OTS was evaluated.
Results:
The mean age of trauma was 6.6±3.1. Of the patients, 9 (26.5%) were female and 25 (73.5%) were male. The most com-mon CT findings are scleral irregularity and increased preseptal thickness (47.1%). In univariate analysis, a P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25-90.0]) and 11 patients with 2 or 3 CT findings (median POTS value 60 [15-70]). A P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25-90.0]) and 7 patients with 4 or more CT findings (median POTS value 45 [25-80]). A P > 0.05 was found between 11 patients with 2 or 3 CT findings (median POTS value 60 [15-70]) and 7 patients with 4 or more CT findings (median POTS value 45 [25-80]). No significant difference was found between the number of CT findings and OTS stages. While POTS was significant (P<0.05) in patients with ab-normal vitreous density (median 45 [30-69.6]), OTS value was not significant (P>0.05). There was no significant difference between POTS and OTS in other CT findings.
Conclusion:
The number of CT findings may assist in predicting POTS and, consequently, estimating visual prognosis in pediatric patients with OGI. In emergency situations where, sufficient clinical data are unavailable, the objective findings from CT may help in assessing the severity of ocular trauma and potentially predicting long-term visual outcomes.
... This study, then, aims to explore the distribution of final vision as well as the proportions of final vision compared to the Ocular Trauma Score (OTS) study [11]. Additionally, the current characteristics and visual outcomes of eye injuries with retained IOFB were also assessed. ...
... Vitreous hemorrhage was assumed if the fundus could be assessed but the characteristics of the small retinal arteries or retinal nerve fiber were obscured. In addition, the distribution of final vision in each OTS category compared to the estimated values from the OTS study was assessed by testing for equality of proportions [11]. Statistical calculation was performed using the STATA® program. ...
Introduction
Retained intraocular foreign body (IOFB) remains an important cause of acquired visual impairment. The visual prognosis following treatments for eyes with retained IOFB was observed to be distinct from other mechanisms of open globe injury due to the specific nature and associated circumstances. This study evaluated the risk behaviors, visual results, and predictive values of Ocular Trauma Score (OTS) in determining visual outcomes in patients with IOFB that were not related to terrorism.
Methods
Medical records of patients who underwent surgical interventions between January 2015 and December 2020 were retrospectively reviewed.
Results
A total of one hundred and sixty-one patients (162 eyes) were recruited. The patients had a mean (standard deviation) age of 47.6 (14.0) years with working male predominance (93.2%). The majority of patients were injured by activities related to grass trimming (63.4%) and metallic objects were the main materials causing injuries (75.7%). Following treatments, the proportion of eyes having vision worse than 20/400 decreased from 126 eyes (77.8%) to 55 eyes (33.9%) at final visit. Ocular trauma score (OTS) had a high potential prediction for final vision in eyes in OTS categories 4 and 5. However, the discordance of final visual acuity distribution was observed in some subgroups of eyes in OTS categories 1 to 3.
Conclusion
This study highlights the significance of IOFB related eye injuries in a tertiary care setting. Decision making on treatments should be carefully considered, particularly in eyes in lower OTS categories, in light of a rise in the proportion of patients who experience improved vision after IOFB removal.
... We presented a case of an elderly metalworker suffering from closed globe injury, a subset of ocular trauma. Ocular trauma is an important cause of visual impairment and preventable blindness that can significantly impact quality of life [6,7]. Moreover, associated penetrating injuries can cause lacerations to the palpebra, intraocular hemorrhage, retained foreign bodies, or tractive retinal detachment [3]. ...
... Therefore, the American Academy of Ophthalmology (AAO) recommends a 48hour window for surgery initiation after patient presentation, should surgery be needed [8]. The first standard procedure in open ocular trauma is to restore the structural integrity as soon as possible [7,9]. ...
Introduction and importance:
Cases of ocular trauma in developing countries are often found with more severe conditions due to increased socioeconomic burden, inadequate safety measures, lack of optimal treatment facilities, and poor education. Here we present a case on an elderly worker in a developing country, showing the importance of prompt treatment albeit in a resource-limited setting.
Case presentation:
A 61-year-old male metalworker presented with closed globe injury after metal debris impact during his work shift 3 h ago. Physical examination showed left eye visual acuity of 1/60, conjunctival injection, corneal blood and fibrovascular tissue, a small foreign body, relative afferent papillary defect, and lens opacities. Ultrasound confirmed vitreous cavity abnormalities. Surgical removal of a foreign body and scleral suturing were performed after an 8-hour delay due to limited staff during night shift. Postoperative follow-up indicated improved vision acuity to 3/60. While the overall prognosis was favorable, the patient did not attend subsequent outpatient follow-up appointments, possibly due to financial barriers, raising concerns regarding long-term management.
Clinical discussion:
Ocular trauma remains a significant contributor to visual impairment and avoidable blindness, carrying potential long-term implications for quality of life. This case presentation serves as a poignant reminder of the socioeconomic repercussions of ocular injuries, particularly among workers in resource-constrained environments of the developing world.
Conclusion:
The notable delays in timely surgical intervention, coupled with financial limitations underline the multifaceted nature of barriers faced.
... En relación a las lesiones oculares, la mayoría de los casos fueron traumas oculares cerrados. Sin embargo, el 28% de los pacientes presentó un trauma ocular abierto, y el 31% tenía una AV al ingreso menor a 20/200, 2 de los factores de peor pronóstico en relación al trauma ocular (20). También destacar que el 9,4% de los pacientes requirió evisceración del contenido intraocular, con secuelas estéticas y funcionales irreversibles. ...
Introducción: Las bombas lacrimógenas (BL) son herramientas de dispersión en contexto de movilizaciones, generando principalmente molestias temporales a nivel ocular, cutáneo y respiratorio. Hay escasos registros de lesiones oculares traumáticas por BL. Objetivos: Describir una serie de casos de trauma ocular (TO) secundario a BL que consultaron a la Unidad de Trauma Ocular del Hospital del Salvador entre el 18 de octubre y 30 de noviembre de 2019. Materiales y Métodos: Estudio descriptivo observacional. Se analizaron datos demográficos, diagnóstico principal y secundarios, presencia de TO grave, agudeza visual (AV) al ingreso y necesidad de cirugía. Resultados: Se incluyeron 32 pacientes, 28 hombres (87,5%) y 4 mujeres (12,5%). La edad promedio fue 32,3 años (rango 16-51). El diagnóstico principal fue TO cerrado en 20 casos (62,5%), y TO abierto en 9 (28,1%). Según criterios de Garantías Explícitas de Salud, 26 (81,3%) fueron catalogados como TO grave. 23 pacientes (71,9%) ingresaron con algún grado de déficit visual, destacando 10 pacientes (31,3%) cuya AV al ingreso fue catalogada como ceguera. 8 pacientes (25%) necesitaron cirugía, siendo lo más frecuente el cierre de TO abierto (50%) y la evisceración del contenido intraocular (37,5%). Discusión: Las BL son usadas frecuentemente por las fuerzas de orden para dispersar manifestaciones debido a su capacidad para generar discapacidad temporal. Sin embargo, pueden generar graves consecuencias a la salud, incluida la secuela visual permanente.
... The OTS is a comprehensive scoring system that incorporates initial VA, the extent of ocular trauma and the presence or absence of elements such as globe rupture, endoph-thalmitis, RD and relative afferent pupillary defect (RAPD). In general, a higher OTS score tends to be indicative of a more favorable prognosis [59]. Numerous studies have assessed the predictability of the OTS. ...
Aim: The aim of this study was to evaluate the visual outcome of lens dislocation and subluxation managed by pars plana vitrectomy (PPV) and lensectomy in patients with open (OGIs) or closed globe injuries (CGIs). Methods: Medical records of 70 consecutive patients treated by PPV and lensectomy over a period of 11 years (1 January 2010–31 December 2020) were retrospectively reviewed. We collected demographic data, best corrected visual acuity (BCVA) using a Snellen Chart pre- and postoperatively, associated ocular injuries and treatment strategy. Visual outcome was evaluated according to the final BCVA which was defined as poor <0.1 or good ≥0.1. Results: The mean age was 57.9 ± 17.6 years. CGIs were present in 49 (70.0%) cases and open OGIs in 21 (30.0%) cases. The dislocation mechanism was zonular lysis in 59 cases (84.3%) and capsular rupture in 11 cases (15.7%). The intraocular lens implant (IOL) was sutured to the sclera in 51 (72.9%) cases or positioned in the capsular bag or in the sulcus in 3 (4.3%) cases and 1 (1.4%) case, respectively, whereas 15 (21.4%) patients remained aphakic. A good BCVA ≥ 0.1 was achieved in 45.71% of the eyes. The presence of retinal detachment (RD) (p = 0.014), iridodonesis (p = 0.011) and initial BCVA (p = 0.000) achieved statistical significance in predicting visual outcome. After treatment, 45.71% of patients achieved a final BCVA ≥ 0.1. Conclusion: RD, iridodonesis and initial BCVA were risk factors for poor visual outcome in our series.
... Fourth, not all evaluated cases had longterm follow-up data, and the long-dated changes and treatment outcomes of some injured eyes were unknown. Fifth, due to the lack of accurate records of relative afferent pupillary defect in many medical records, ocular trauma scores (45) cannot be used to evaluate and compare vision outcomes impaired by different sports or injury causes. Lastly, this study mainly analyzed popular sports in China, but lacks data on popular sports in other countries such as baseball. ...
Objective
To investigate the epidemiological and clinical characteristics of sports-related eye injuries in China, as well as how they differ depending on the sport or other specific factor that caused them.
Methods
Consecutive medical records from 2015 to 2019 of sports-related eye injuries from a standardized database in nine tertiary referral hospitals in China were retrospectively reviewed and analyzed.
Results
A total of 377 eyes in 376 inpatients (mean age, 22.5 ± 7.3 years; men:women 15.4:1) were included. Soccer (46.8%), basketball (27.1%), and badminton (16.8%) were the top three sports that caused injury. Ball strikes (74.7%), physical collision (13.8%), and racket/equipment beating (9.0%) were the common specific causes of injury. Blunt force injuries (95.8%) and close globe injuries (95.1%) accounted for the majority of injuries. Open globe injuries occurred more in basketball (8.3%) than in other sports, mainly due to physical collision (12.8%) and racket/equipment beating (11.8%). Basketball (13.4%) or physical collision (21.3%) caused Zone I injuries more frequently than other sports. Soccer (60.5%) and basketball (54.6%) caused more injuries to the posterior segment of the eyeball than other sports, mainly due to ball strikes (96.6%). Badminton (69.8%) and racket beating (61.8%) caused more Zone II globe injuries than other sports. In badminton, the percentage of hyphema (85.7%), the most typical symptom of eye damage, and ultimate visual acuity (VA) ≥20/40 (88.9%) was the greatest. A final low vision score of (≤4/200) was observed in 10.6% of all participants, including three participants who had an eye removed due to rupturing. The final VA was positively correlated with the presenting VA ( r = 0.421).
Conclusion
Sports can lead to high proportions of ocular contusion injury and low vision. VA prognosis is closely related to initial VA following ocular sports trauma, which is directly determined by the causative sports and/or the specific causes. Effective eye protection is imperative to avoid or reduce visual impairments of sports participants.
Purpose
The aim of this study was to describe variations in practice patterns for the management of zone 1 open globe injuries among corneal specialists worldwide.
Methods
This cross-sectional study was performed using an online survey distributed to members of The Cornea Society. Responses were collected between September 9, 2021, and September 30, 2021.
Results
Of 94 responses included in analysis, respondents averaged 18.2 ± 14.5 years of postfellowship experience. Among respondents, 53 (56.4%) were affiliated with an academic institution and 41 (43.6%) with private practice. Ophthalmologists practicing in the United States were significantly more likely to use an eye shield preoperatively (98.5% vs. 85.7%, P = 0.03) and less likely to perform primary lensectomy in cases of lens involvement (40.9% vs. 75.0%, P = 0.002) compared with those practicing outside the United States. Ophthalmologists in practice fewer than 10 years were more likely to administer preoperative systemic antibiotics (91.4% vs. 66.1%, P = 0.006) and tetanus prophylaxis (88.6% vs. 67.8%, P = 0.03), and to obtain preoperative computed tomography scans (85.7% vs. 54.2%, P = 0.002) compared with more senior physicians. Ophthalmologists at academic institutions were more likely to perform preoperative B-scan (30.2% vs. 9.8%, P = 0.02), use general anesthesia (90.6% vs. 70.7%, P = 0.03), and admit for postoperative antibiotics (28.3% vs. 9.8%, P = 0.04), and were less likely to perform surgery overnight (45.3% vs. 70.7%, P = 0.02) compared with private practice physicians.
Conclusions
There is significant variation in the practice patterns for the management of zone 1 open globe injuries among corneal specialists, which presents an opportunity to investigate whether certain treatment options lead to better outcomes in these injuries.
We describe seven patients who were attempting to repair their garage door when a spring dislodged at high velocity, resulting in open globe injury. All patients were seen at Massachusetts Eye and Ear between the years 2008 and 2023. Their final visual acuities ranged from 20/125 to no light perception. Open globe injury appears to be a risk of attempts to repair a garage door by people who are inexperienced in doing so.
[ Ophthalmic Surg Lasers Imaging Retina 2023;54:xx–xx.]
To investigate the clinical and computer tomography (CT) features and visual prognostic factors of pars plana vitrectomy (PPV) for management of retained posterior segment intraocular foreign body (IOFB). Medical records of 96 patients with IOFB removed by PPV between July 2017 and June 2021 were retrieved. The medical records, including demographic data, initial and final best corrected visual acuity (BCVA) using standard Snellen chart, characteristics of IOFB, CT findings, and surgical details, were reviewed. Outcome was evaluated according to the final BCVA and prognostic factors were obtained. The mean age was 42.31 ± 12.05 years (range 13–71 years) with 94 males (97.9%) and two females (2.1%). CT was sensitive of IOFB in 93.75% (90 eyes) and the locations were consistent with that found during PPV: 20 foreign bodies were located in vitreous, 6 near ciliary body, and 70 on or in retina. Mean diameter of IOFB removed by PPV is 3.52 mm ± 3.01 mm (range 1–22; median 3), and mean area is 6.29 ± 6.48 mm² (range 0.5–40; median 3), which was statistically associated with the initial VA < 0.1 and endophthalmitis. Endophthalmitis was found in 24 (25.0%) eyes and large wound together with scleral entry site might be related to the endophthalmitis. Visual outcome < 0.1 was associated with relative afferent pupillary defect, initial VA < 0.1, and presence of endophthalmitis. Initial VA ≥ 0.1 was independent predictive factor for a better final BCVA. Relative afferent pupillary defect, initial BCVA < 0.1, and presence of endophthalmitis are poor visual prognostic factors.