A Statistical Observation of Ocular Injuries and Visual Predictive Value of Ocular Trauma Score

Jun Ho Yoo; Hwa Lee; Jongmi Lee; Tae Soo Lee; Sehyun Baek

doi:10.3341/jkos.2011.52.9.1024

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Yoo, Lee, Lee, Lee, and Baek: A Statistical Observation of Ocular Injuries and Visual Predictive Value of Ocular Trauma Score

Original Article

J Korean Ophthalmol Soc 2011;52(9):1024-1029.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.9.1024

A Statistical Observation of Ocular Injuries and Visual Predictive Value of Ocular Trauma Score

Jun Ho Yoo, MD¹, Hwa Lee, MD¹, Jongmi Lee, MD², Tae Soo Lee, MD, PhD¹, Sehyun Baek, MD, PhD¹

¹Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

²Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Address reprint requests to Sehyun Baek, MD, PhD Department of Ophthalmology, Korea University Ansan Hospital #516 Gojan 1-dong, Danwon-gu, Ansan 425-707, Korea Tel: 82-31-412-5160, Fax: 82-31-414-8940, E-mail: shbaek6534@korea.ac.kr

Received 20 September 2010 Revised 5 February 2011 Accepted 12 July 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical characteristics of ocular injuries for the prevention and predictability of visual prognosis and the treatment of ocular injuries using the ocular trauma score.

Methods

A retrospective survey was performed in 1341 eyes of 1257 patients, who visited Korea University Medical Center from May 2009 to December 2009. The sex, age, causes, diagnosis, primary ocular surgery, injury site, initial and final visual acuities and complications were statistically reviewed. The ocular trauma score was calculated by assigning certain numerical raw points to the following six variables: initial visual acuity, globe rupture, endophthalmitis, perforating injury, retinal detachment, and a relative afferent pupillary defect. The correlation of the ocular traumascore with the final visual acuity was investigated.

Results

The incidence of ocular injuries was higher in males (79.0%) than in females and was more common in people in their 40s and 20s respectively. Among the patient the diagnoses, corneal erosion was most common in males, orbital wall fracture was most common in females, and corneal erosion, orbital wall fracture, orbital contusion, and hyphema were most common overall. An ocular trauma score was less than 44 in 6 eyes (0.7%), 9 eyes (1.0%) between a score of 45 and 65, 48 eyes (5.2%) between a score of 66 and 80, 122 eyes (13.2%) between a score of 81 and 90, and 737 eyes (79.9%) between a score of 91 and 100.

Conclusions

The present study determined that the ocular trauma score showed a good visual predictive value and could be used in prevention and treatment of ocular injuries.

Keywords: Ocular injury, Ocular trauma score, Visual acuity

References

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Figure 1.

Final visual acuity and Ocular trauma score in our study. OTS = ocular trauma score; NLP = no light perception; LP = light perception; HM = hand motion. The lower ocular trauma score was, the worse final visual acuity was.

Table 1.

Calculating the ocular trauma score (OTS): variables and raw points

Variables	Raw points
Initial vision	
No light perception	60
Light perception /Hand motion	70
0.05–0.1	80
0.1–0.4	90
≥ 0.5	100
Rupture	−23
Endophthalmitis	−17
Perforating injury	−14
Retinal detachment	−11
Relative afferent pupillary defect	−10

Table 2.

Ocular trauma score

Sum of raw points	Ocular trauma score
0–44	1
45–65	2
66–80	3
81–91	4
92–100	5

Table 3.

Characteristics of patients

Characteristic	Results
Patients (eye)	1257 (1341)
Sex (M/F)	993/264
Laterality (OD/OS/OU)	586/587/84
Age (mean ± SD, range, yr)	32.8 ± 16.5 (1–90)

Table 4.

Distribution of visual acuity: initial & final visual acuity

Visual acuity	No. of eyes on first visit (%)	No. of eyes on last visit (%)
No light perception	7 (0.5)	10 (0.7)
Light perception-Hand motion	25 (1.8)	5 (0.3)
0.05–0.1	11 (0.8)	6 (0.4)
0.1–0.4	147 (10.9)	108 (8.0)
≥ 0.5	1095 (81.6)	793 (59.1)
Not checked, GCM^*	56 (4.1)	419 (31.2)
Total	1341 (100)	1341 (100)

^* GCM = good, central, and maintained.

Table 5.

Types of ocular injuries

Type of ocular injury	No. of case	%
Corneal abrasion (SPK^*, PEE^†)	335	17.60
Blowout fracture	310	16.29
Orbital contusion	220	11.56
Hyphema	173	9.09
Commotio retina	132	6.94
Corneal foreign body	113	5.94
Traumatic iridocyclitis	105	5.52
Subconjunctival hemorrhage	86	4.52
Conjuntival foreign body	43	2.26
Conjuntival laceration	42	2.21
Retinal hemorrhage	29	1.52
Corneal laceration	28	1.47
Retinal tear	24	1.26
Canalicular lacearation	15	0.79
Vitreous hemorrhage	13	0.68
Eyeball rupture	12	0.63
Lid laceration	11	0.58
Traumatic cataract	10	0.53
Retrobulbar hemorrhage	8	0.42
Intraocular foreign body	7	0.37
Scleral laceration	5	0.26
Lens malposition (drop, donesis, dislocation)	5	0.26
Retinal detachment	1	0.05
Retinal dialysis	0	0.00
etc^‡	176	9.25
	1903	100

^* SPK = superficial punctuate keratitis

^† PEE = punctate epithelial erosion

^‡ Conjunctival abrasion, posterior vitreous detachment, nasal bone fracture, zygoma fracture, skull fracture, intra-cerebral hemorrhage.

Table 6.

Types of ocular injuries according to sex

Type of ocular injury	Male	Female
Corneal abrasion (SPK^*, PEE^†)	264 (19.2%)	71 (13.4%)
Blowout fracture	233 (17.0%)	77 (14.5%)
Orbital contusion	173 (12.6%)	47 (8.9%)
Hyphema	112 (8.16%)	61 (11.5%)
Commotio retina	90 (6.56%)	42 (7.9%)
Corneal foreign body	89 (6.49%)	24 (4.5%)
Traumatic iridocyclitis	79 (5.76%)	26 (4.9%)
Subconjunctival hemorrhage	61 (4.45%)	25 (4.7%)
Conjuntival foreign body	39 (2.84%)	4 (0.8%)
Conjuntival laceration	27 (1.97%)	15 (2.8%)
Corneal laceration	22 (1.60%)	6 (1.1%)
Retinal hemorrhage	18 (1.31%)	11 (2.1%)
Lid laceration	10 (0.73%)	1 (0.2%)
Retinal tear	7 (0.51%)	17 (3.2%)
Eyeball rupture	6 (0.44%)	6 (1.1%)
Vitreous hemorrhage	5 (0.36%)	8 (1.5%)
Retrobulbar hemorrhage	5 (0.36%)	3 (0.6%)
Intraocular foreign body	5 (0.36%)	2 (0.4%)
Canalicular lacearation	4 (0.29%)	11 (2.1%)
Lens malposition (drop, donesis, dislocation)	4 (0.29%)	1 (0.2%)
Traumatic cataract	3 (0.22%)	7 (1.3%)
Scleral laceration	3 (0.22%)	2 (0.4%)
Retinal detachment	1 (0.07%)	0 (0.0%)
Retinal dialysis	0 (0.00%)	0 (0.0%)
etc^‡	112 (8.16%)	64 (12.1%)
	1372 (100%)	531 (100%)

^* SPK = superficial punctuate keratitis

^† PEE = punctate epithelial erosion

^‡ conjunctival abrasion, posterior vitreous detachment, nasal bone fracture, zygoma fracture, skull fracture, intra-cerebral hemorrhage.

Table 7.

Types of ocular injuries in patients that initial visual acuity was NLP^* or LP^†/HM ^‡

Type of ocular injury	No. of case	%
Hyphema	20	27.8
Eyeball rupture	9	12.5
Blowout fracture	7	9.7
Corneal laceration	6	9.3
Intraocular foreign body	4	5.6
Retinal hemorrhage	4	5.6
Lens malposition (drop, donesis, dislocation)	4	5.6
Commotio retina	3	4.2
Orbital contusion	2	2.8
Traumatic iridocyclitis	2	2.8
Retrobulbar hemorrhage	2	2.8
Scleral laceration	1	1.4
Retinal detachment	1	1.4
Vitreous hemorrhage	1	1.4
Lid laceration	1	1.4
etc^§	5	6.9
	72	100

^* NLP = no light perception

^† LP = light perception

^‡ HM = hand motion

^§ nasal bone fracture, zygoma fracture, skull fracture.

Table 8.

Final visual acuity and ocular trauma score

Sum of raw points	OTS^*	NLP^†	LP^‡/HM^§	0.05–0.1	0.1–0.4	≥ 0.5	Total
0–44	1	^∏ 5 (83.3%)	1 (16.7%)	0	0	0	6 (0.7%)
45–65	2	3 (33.3%)	2 (22.2%)	1 (11.1%)	3 (33.3%)	0	9 (1.0%)
66–80	3	2 (4.2%)	2 (4.2%)	5 (10.4%)	8 (16.7%)	31 (64.6%)	48 (5.2%)
81–90	4	0	0	0	58 (47.5%)	64 (52.5%)	122 (13.2%)
91–100	5	0	0	0	39 (5.3%)	698 (94.7%)	737 (79.9%)
Total		10	5	6	108	793	922

^* OTS = ocular trauma score

^† NLP = no light perception

^‡ LP = light perception

^§ HM = hand motion

^∏ numbers of eyes.

Table 9.

Final visual acuity and ocular trauma score-comparison with Kuhn's study

Sum of raw points	OTS^*	NLP^†	LP^‡/HM^§	0.05–0.1	0.1–0.4	≥ 0.5
Sum of raw points	OTS^*	A/A' (%/%)	A/A' (%/%)	A/A' (%/%)	A/A' (%/%)	A/A' (%/%)
0–44	1	74/83.3	15/16.7	7/0	3/0	1/0
0–44	1	^∏ p:0.121	p:0.7	p:0.007	p:0.081	p:0.316
45–65	2	27/33.3	26/22.2	18/11.1	15/33.3	15/0
45–65	2	p:0.355	p:0.508	p:0.160	p:0.003	p<0.001
66–80	3	2/4.2	11/4.2	15/10.4	31/16.7	41/64.6
66–80	3	p:0.407	p:0.06	p:0.285	p:0.02	p:0.001
81–90	4	1/0	2/0	3/0	22/47.5	73/57.5
81–90	4	p:0.316	p:0.155	p:0.081	p <0.001	p:0.02
91–100	5	0/0	1/0	1/0	5/5.3	94/94.7
91–100	5	0/0	p:0.316	p:0.316	p:1.0	p:0.756

A = Kuhn's study results; A' = Our study results.

^* OTS = ocular trauma score

^† NLP = no light perception

^‡ LP = light perception

^§ HM = hand motion

^∏ p-value was calculated by χ² test.

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