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Controversies in ocular trauma classification and management: review

  • Controversies in Ophthalmology
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Abstract

Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide. There are unresolved issues regarding the management of OGIs involving the posterior segment. Timing of vitrectomy has been and will continue to be debated by proponents of early versus delayed intervention. The use of prophylactic cryotherapy and scleral buckle is still practiced differently throughout the world. The role of intravitreal antibiotics in posterior segment trauma in the absence of infection is still debated. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved. In optic neuropathy, the role of intravenous methylprednisolone versus conservative management is always debated and still there are no evidence-based guidelines about the beneficial role of pulse steroid therapy. The role of optic canal decompression in the setting of acute traumatic optic neuropathy is also not conclusive. Orbital and adnexal trauma has been shown to adversely affect the outcome of OGI patients but both lids and orbital injury are not taken as preoperative variables in international ocular trauma classification. The timing of intervention in blow-out fracture is still debated. The pediatric age group, owing to the high risk of amblyopia and intraocular inflammation as well as strong vitreoretinal adhesions, has to be managed by different principles. Although the risk of sympathetic ophthalmia is very rare, it is always one of the key debated issues while managing traumatized eyes with no light perception vision. Prospective, controlled clinical studies are not possible in the OGI setting and this article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors’ personal experience.

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References

  1. Pieramici DJ, Sternber P Jr, Aaberg TM Sr et al (1997) A system for classifying mechanical injuries of the eye (globe). Am J Ophthalmol 123:820–831

    PubMed  CAS  Google Scholar 

  2. Straatsma BR, Landers MB, Kreiger AE (1968) The ora serrata in the adult human eye. Arch Ophthalmol 80:3

    Article  PubMed  CAS  Google Scholar 

  3. Sherman DD, Lemke BN (1997) Orbital anatomy and its clinical applications. In: Tasman W, Jaeger EA (eds) Duane’s clinical ophthalmology, vol 2, Chapter 21. Lippincott Raven, Philadelphia, pp 13–20

  4. Knyazer B, Levy J, Rosen S, Belfair N, Klemperer I, Lifshitz T (2008) Prognostic factors in posterior open globe injuries (zone-III injuries). Clin Exp Ophthalmol 36(9):836–841

    Article  Google Scholar 

  5. Morris R, Kuhn F, Witherspoon CD (1999) Management of the opaque media eye with no light perception. In: Alfaro DV III, Liggett PE (eds) Vitreoretinal surgery of the injured eye. Lippincott Raven, Philadelphia, pp 113–124

    Google Scholar 

  6. Striph GG, Halperin LS, Stevens JL et al (1988) Afferent pupillary defect caused by hyphema [letters]. Am J Ophthalmol 106:352–353

    Article  PubMed  CAS  Google Scholar 

  7. Abrams GW, Kington RW (1984) Falsely extinguished bright light flash electroretinogram. Its association with dense vitreous hemorrhage. Arch Ophthalmol 100:1427–1429

    Article  Google Scholar 

  8. Rabinowitz R, Yagev R, Shoham A et al (2004) Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage. Eye 18:253–256

    Article  PubMed  CAS  Google Scholar 

  9. Makley TA Jr, Azar A (1978) Sympathetic ophthalmia. A long-term follow-up. Arch Ophthalmol 96:257–262

    Article  PubMed  Google Scholar 

  10. Tabatabaei SA, Soleimani M, Alizadeh M, Movasat M, Mansoori MR, Alami Z, Foroutan A, Joshaghani M, Safari S, Goldiz A (2011) Predictive value of visual evoked potentials, relative afferent pupillary defect, and orbital fractures in patients with traumatic optic neuropathy. Clin Ophthalmol 5:1021–1026

    PubMed  Google Scholar 

  11. Turner A, Rabiu M (2006) Patching for corneal abrasion. Cochrane Database Syst Rev 19 April(2). Art. No.: CD004764

  12. Kaiser PK (1995) A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Ophthalmology 102:1936–1942

    PubMed  CAS  Google Scholar 

  13. Kuhn F (2010) Traumatic cataract: what, when, how. Graefes Arch Clin Exp Ophthalmol 248(9):1221–1223. Epub 29 Apr 2010

    Google Scholar 

  14. Cardillo J, Stout J, LaBree L, Azen S, Omphroy L, Cui J, Kimura H, Hinton D, Ryan S (1997) Posttraumatic proliferative vitreoretinopathy. The epidemiologic profile, onset, risk factors, and visual outcome. Ophthalmology 104:1166–1173

    Article  PubMed  CAS  Google Scholar 

  15. Shah MA, Shah SM et al (2011) Effect of interval between time of injury and timing of intervention on final visual outcome in cases of traumatic cataract. Eur J Ophthalmol 21(6):760–765

    Article  PubMed  Google Scholar 

  16. Shah MA, Shah SM et al (2011) Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients. Indian J Ophthalmol 59(3):217–222

    Article  PubMed  Google Scholar 

  17. Shah MA, Shah SM et al (2011) Comparative study of final visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract. Graefes Arch Clin Exp Ophthalmol 249(12):1775–1781

    Article  PubMed  Google Scholar 

  18. Shah MA, Shah SM et al (2012) Ocular Trauma Score: a useful predictor of visual outcome at six weeks in patients with traumatic cataract. Ophthalmology 119(7):1336–1341

    Article  PubMed  Google Scholar 

  19. Shah MA, Shah SM et al (2012) Ocular Trauma Score as a predictor of final visual outcomes in traumatic cataract cases in pediatric patients. J Cataract Refract Surg 38(6):959–965

    Article  PubMed  Google Scholar 

  20. Rumelt S, Rehany U (2010) The influence of surgery and intraocular lens implantation timing on visual outcome in traumatic cataract. Graefes Arch Clin Exp Ophthalmol 248:1293–1297

    Article  PubMed  Google Scholar 

  21. Cohen KL (2001) Inaccuracy of intraocular lens power calculation after traumatic corneal laceration and cataract. J Cataract Refract Surg 27(9):1519–1522

    Article  PubMed  CAS  Google Scholar 

  22. Shah MA, Shah SM et al (2011) Morphology of traumatic cataract: does it play a role in final visual outcome? BMJ Open 1(1):e000060

    Article  PubMed  Google Scholar 

  23. Brar GS, Ram J, Pandav SS, Reddy GS, Singh U, Gupta A (2001) Postoperative complications and visual results in uniocular pediatric traumatic cataract. Ophthalmic Surg Lasers 32(3):233–238

    PubMed  CAS  Google Scholar 

  24. Koenig SB, Ruttum MS, Lewandowski MF, Schultz RO (1993) Pseudophakia for traumatic cataracts in children. Ophthalmology 100(8):1218–1224

    PubMed  CAS  Google Scholar 

  25. Gharaibeh A, Savage HI, Scherer RW, Goldberg MF, Lindsley K (2011) Medical interventions for traumatic hyphema. Cochrane Database Syst Rev 19 Jan(1):CD005431 (review)

    Google Scholar 

  26. Girkin CA, McGwin G Jr, Morris R, Kuhn F (2005) Glaucoma following penetrating ocular trauma: a cohort study of the United States Eye Injury Registry. Am J Ophthalmol 139(1):100–105

    Article  PubMed  Google Scholar 

  27. Mittra RA, Mieler WF (1999) Controversies in the management of open-globe injuries involving the posterior segment. Surv Ophthalmol 44(3):215–225 (review)

    Article  PubMed  CAS  Google Scholar 

  28. Spalding SC, Sternberg P Jr (1990) Controversies in the management of posterior segment ocular trauma. Retina 10(Suppl 1):S76–S82 (review)

    Article  PubMed  Google Scholar 

  29. Essex RW, Yi Q, Charles PG et al (2004) Post-traumatic endophthalmitis. Ophthalmology 111(11):2015–2022

    Article  PubMed  Google Scholar 

  30. Mieler WF, Mittra RA (1997) The role and timing of pars plana vitrectomy in penetrating ocular trauma. Arch Ophthalmol 115(9):1191–1192

    Article  PubMed  CAS  Google Scholar 

  31. Dalma-Weiszhausz J, Quiroz-Mercado H, Morales-Cantón V, Oliver-Fernandez K, De Anda-Turati M (1996) Vitrectomy for ocular trauma: a question of timing? Eur J Ophthalmol 6(4):460–463

    PubMed  CAS  Google Scholar 

  32. Coleman DJ (1982) Early vitrectomy in the management of the severely traumatized eye. Am J Ophthalmol 93:543–551

    PubMed  CAS  Google Scholar 

  33. De Juan E Jr, Sternberg P Jr, Michels RG (1984) Timing of vitrectomy after penetrating ocular injuries. Ophthalmology 91:1072–1074

    PubMed  Google Scholar 

  34. Ahmadieh H, Soheilian M, Sajjadi H, Azarmina M, Abrishami M (1993) Vitrectomy in ocular trauma. Factors influencing final visual outcome. Retina 13(2):107–113

    Article  PubMed  CAS  Google Scholar 

  35. Han DP, Mieler WF, Schwartz DM, Abrams GW (1990) Management of traumatic hemorrhagic retinal detachment with pars plana vitrectomy. Arch Ophthalmol 108:1281–1286

    Article  PubMed  CAS  Google Scholar 

  36. Hutton WL, Fuller DG (1984) Factors influencing final visual results in severely injured eyes. Am J Ophthalmol 97:715–722

    PubMed  CAS  Google Scholar 

  37. Rubsamen PE, Cousins SW, Winward KE, Byrne SF (1994) Diagnostic ultrasound and pars plana vitrectomy in penetrating ocular trauma. Ophthalmology 101:809–814

    PubMed  CAS  Google Scholar 

  38. Hsu HT, Ryan SJ (1986) Experimental retinal detachment in the rabbit. Penetrating ocular injury with retinal laceration. Retina 6:66–69

    Article  PubMed  CAS  Google Scholar 

  39. Vatne HO, Syrdalen P (1985) Vitrectomy in double penetrating eye injuries. Acta Ophthalmol (Copenh) 63:552–556

    Article  CAS  Google Scholar 

  40. Steinsapir KD, Goldberg RA (2011) Traumatic optic neuropathy: an evolving understanding. Am J Ophthalmol 151(6):928.e2–933.e2. Epub 6 May 2011 (review)

    Google Scholar 

  41. Yu Wai Man P, Griffiths PG (2011) Steroids for traumatic optic neuropathy. Cochrane Database Syst Rev 19 Jan(1):CD006032 (review)

  42. Yu Wai Man P, Griffiths PG (2005) Surgery for traumatic optic neuropathy. Cochrane Database Syst Rev 19 Oct(4):CD005024 (review)

  43. Chou PI, Sadun AA, Chen YC, Su WY, Lin SZ, Lee CC (1996) Clinical experiences in the management of traumatic optic neuropathy. Neuro-Ophthalmology 16(6):325–336

    Article  Google Scholar 

  44. Cook MW, Levin LA, Joseph MP, Pinczower EF (1996) Traumatic optic neuropathy. A meta-analysis. Arch Otolaryngol Head Neck Surg 122(4):389–392

    Article  PubMed  CAS  Google Scholar 

  45. Joseph MP, Lessell S, Rizzo J, Momose J (1990) Extracranial optic nerve decompression for traumatic optic neuropathy. Arch Ophthalmol 108(8):1091–1093

    Article  PubMed  CAS  Google Scholar 

  46. Lee V, Ford RL, Xing W, Bunce C, Foot B (2010) Surveillance of traumatic optic neuropathy in the UK. Eye 24(2):240–250

    Article  PubMed  CAS  Google Scholar 

  47. Levin LA, Beck RW, Joseph MP, Seiff S, Kraker R (1999) The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study. Ophthalmology 106(7):1268–1277

    Article  PubMed  CAS  Google Scholar 

  48. Maltzman BA, Pruzon H, Mund ML (1976) A survey of ocular trauma. Surv Ophthalmol 21:285–290

    Article  PubMed  CAS  Google Scholar 

  49. Schein OD, Hibberd PL, Shingleton BJ et al (1988) The spectrum and burden of ocular injury. Ophthalmology 95:300–305

    PubMed  CAS  Google Scholar 

  50. Lemley CA, Han DP (2007) An age-based method for planning sclerotomy placement during pediatric vitrectomy: a 12-year experience. Trans Am Ophthalmol Soc 105:86–89

    PubMed  Google Scholar 

  51. Hairston RJ, Maguire AM, Vitale S, Green WR (1997) Morphometric analysis of pars plana development in humans. Retina 17:135–138

    Article  PubMed  CAS  Google Scholar 

  52. Aiello AL, Tran VT, Rao NA (1992) Postnatal development of the ciliary body and pars plana. A morphometric study in childhood. Arch Ophthalmol 110:802–805

    Article  PubMed  CAS  Google Scholar 

  53. Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD (2002) The Ocular Trauma Score (OTS). Ophthalmol Clin N Am 15:163–165

    Article  Google Scholar 

  54. Unver YB, Acar N, Kapran Z, Altan T (2008) Visual predictive value of the ocular trauma score in children. Br J Ophthalmol 92:1122–1124

    Article  PubMed  CAS  Google Scholar 

  55. Uysal Y, Mutlu FM, Sobaci G (2008) Ocular Trauma Score in childhood open-globe injuries. J Trauma 65:1284–1286

    Article  PubMed  Google Scholar 

  56. Acar U, Tok OY, Acar DE, Burcu A, Ornek F (2011) A new ocular trauma score in pediatric penetrating eye injuries. Eye 25:370–374

    Article  PubMed  CAS  Google Scholar 

  57. Gupta A, Rahman I, Leatherbarrow B (2009) Open globe injuries in children: factors predictive of a poor final visual acuity. Eye 23:621–625

    Article  PubMed  CAS  Google Scholar 

  58. Grieshaber MC, Stegmann R (2006) Penetrating eye injuries in South African children: aetiology and visual outcome. Eye 20:789–795

    Article  PubMed  CAS  Google Scholar 

  59. Rostomian K, Thach AB, Isfahani A, Pakkar A, Pakkar R, Borchert M (1998) Open globe injuries in children. J AAPOS 2:234–238

    Article  PubMed  CAS  Google Scholar 

  60. Mireskandari K, Bunting H (2011) Paediatric open globe injuries: a seventeen year experience. Investig Ophthalmol Vis Sci 52(Suppl):1572

    Google Scholar 

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Correspondence to Rupesh Agrawal.

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Agrawal, R., Shah, M., Mireskandari, K. et al. Controversies in ocular trauma classification and management: review. Int Ophthalmol 33, 435–445 (2013). https://doi.org/10.1007/s10792-012-9698-y

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