The Birmingham Eye Trauma Terminology : Suggestions For Re-Inforcement

THE BIRMINGHAM EYE TRAUMA TERMINOLOGY : SUGGESTIONS FOR

RE-INFORCEMENT Token no: 0304

Presenting author: Dr. Anand A. TibdewalCo-authors: Dr. Mehul Shah Dr. Shreya Shah

Dr. Kashyap Patel

There is no financial interest of any of the authors behind conducting this study and no financial assistance was provided by any institute or organization & there are no competing interests.

INTRODUCTION

• Ocular trauma is common, preventable yet the most under-recognized major health problem today. Blindness due to injury is a social and economical burden for every individual. Optimizing visual outcome in ocular injury requires prompt diagnosis and treatment. 1,2, 3

• With the introduction of the Birmingham Eye Trauma Terminology System (BETTS), the documentation of ocular trauma has been standardized.4

• In practice, BETT only concerns mechanical eyeball injury. As a result, eye lid, orbital and ocular adnexa injury cannot be classified by BETT, although part of orbital and ocular adnexa injuries associated with globe injury can be categorized into globe injury by BETT, this classification is still incomplete and misses some information. BETT was proposed 12 year before so it needs some additional information regarding eye lid, orbital and ocular adnexal injuries. 5,6

AIMS & OBJECTIVES• To implement modification in Birmingham Eye Trauma Terminology System

classification for ocular trauma.

Classification of Mechanical Ocular Injuries according to BETT

Study Design:• Prospective And Retrospective Cohort Study.• All patients with ocular trauma in either eye, diagnosed and managed between

January 2002 to December 2015 at Drashti Netralaya, Dahod were included in the study, and patients consenting to participate were included.

Inclusion Criteria:• All patients coming to Drashti Netralaya with ocular trauma.

 Exclusion Criteria: • Severe trauma to other body parts. • Patient with ocular trauma, already treated for the same in any other hospital. Sample size: • 4721

MATERIALS & METHODS

Examination Protocol:• For each patient enrolled, we obtained a detailed history, socioeconomic data, details of

the injury, and information on the eye treatment and surgery performed to manage past ocular trauma. Data for both the initial and follow-up reports were collected using the online BETTS format of the International Society of Ocular Trauma. Details of the surgery were collected using an online form.

• Visual Acuity on presentation of both eyes , Anterior Segment examination by Slit Lamp Biomicroscopy, Posterior Segment examination by Indirect Ophthalmoscope and if media was not clear, then a B-scan was performed to evaluate the posterior segment.

• The surgical technique was selected according to the morphology and the condition of tissues other than the lens. In all patients undergoing corneal wound repair, the traumatic cataract was managed in a second procedure.

• The duration of medical treatment depended on the degree of inflammation in the anterior and posterior segments of the operated eye.

• Data was exported from electronic medical record system, collected in excel sheets and analyzed.

OBSERVATION & RESULTS

Age Incidence Gender Distributuion

Male; 3391; 72%

Fe-male; 1330; 28%

o to 10 11 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 71 to 80 >800

200

400

600

800

1000

1200

699 735 994 825 600 566 260 35 7

AGE OF PATIENTS

Activity at Injury

UNKNOWNSLEEPING

FALLFIGHTING

PLAIN MOBILITYVEHICULAR INJURY

TRAVEL TOPOTHER

PLAYINGJOB WORK

HOME WORK

0 200 400 600 800 1000 1200 1400

1112396512816822977994411311215

VEGETATIVE38%

CHEMICAL5%OTHER

30%

SHARP3%

BLUNT25%

Object Causing Injury

LID

CONJUNCTIV

A

CORN

EA AC IRIS

PUPIL LEN

S

VITREO

USRE

TINA

OPTIC

NERVE

CHOROID

SCLER

AEO

MAN

GLE0

500100015002000250030003500

417

27633044

1015 804370

1213

149 186 46 10 40 16 4

No of Pati...

Ocular Structures Involvement

OTS POINTS AND FINAL VISUAL OUTCOME ( P < 0.01)

NO PL PL HM 1/60 TO 3/60

6/60 TO 6/12

6/12 TO 6/5

0

10

20

30

40

50

60

70

80

90

73

17

72 1

84

12

03

0

PREDICTED ACHIEVED

OTS 1

NO PL PL HM 1/60 TO 3/60

6/60 TO 6/12

6/12 TO 6/5

0

10

20

30

40

50

60

70

80

90

28

1318

13 15

77

82

6 4

PREDICTED ACHIEVED

OTS 2

NO PL PL HM 1/60 TO 3/60

6/60 TO 6/12

6/12 TO 6/5

0

10

20

30

40

50

60

2

1115

28

44

2

48

1714

17

PREDICTED ACHIEVED

NO PL PL HM 1/60 TO 3/60

6/60 TO 6/12

6/12 TO 6/5

0

10

20

30

40

50

60

70

80

1 2 2

21

74

0.5 1 1.5

59

37 PREDICTED ACHIEVED

NO PL PL HM 1/60 TO

3/60

6/60 TO

6/12

6/12 TO 6/5

0

10

20

30

40

50

60

70

80

90

100

0 1 2 5

92

0.5 0.5 1

12

85

PREDICTED ACHIEVED

OTS 3 OTS 4

OTS 5

MECHANICAL EYE INJURY

4721

EYE BALL INJURY(76.5%)

CLOSE GLOBE INJURY55.5%

CONTUSION1333 (28.5%)

LAMELLAR LACERATION

1275 (27%)

OPEN GLOBE INJURY

(21%)

RUPTURE 243 (5%)

LACERATION(16%)

PENETRATING 728 (15%)

PERFORATING 50 (1%)

RETAINED FB(15.5%)

GLOBE FB(15%)

IOFB27 (0.5%)

IMFB 144 (3.50%)

OSFB548 (11%)

EYE LID AND ADNEXAL FB

23 (0.5%)

EYE LID & ADNEXAL

INJURY(7%)

EYE LID INJURY284 (6.0%)

ADNEXAL INJURY22 (0.4%)

ORBITAL INJURY16 (0.2%)

EXTRA OCULAR MUSCLE INJURY

23 (0.4%)

MECHANICAL EYE INJURY

4721

CLOSE GLOBE INJURY(67.5%)

CONTUSION1333 (28.5%)

LAMELAR LACERATION

1275 (27%)

SUP FB549 (12%)

OPEN GLOBE INJURY(21.5%)

RUPTURE244 (5%)

LACERATION(16.5%)

PENETRATING728 (15%)

PERFORATING50 (1%)

IOFB25 (0.5%)

UNCLASSIFIED507 (11%)

OLD CLASSIFICATION NEW PROPOSED CLASSIFICATION

DISCUSSION• Ocular trauma is believed to be one of the significant cause of visual impairment. It can cause a

wide variety of damage to the ocular tissues.• Trauma generally occurs in the younger age group and in males who are commonly involved in

outdoor activities. It is comparatively rare in old age and in females. Most of the people sustain injuries during work, which in a rural setup includes agricultural activity most commonly.

• Trauma can cause a variety of damage to the ocular tissues. This damage can involve both the anterior and posterior segment. The damage can be relatively mild or can be very severe, leading to loss of vision. In mild cases, medical management is sufficient whereas in severe cases, early surgical intervention such as paracentesis, globe repair and vitrectomy is required to restore some useful vision.

CONCLUSION• Standardized international classification of mechanical eyeball injury proposed by BETT

considering incomplete, we propose a new classification of mechanical eye injuries. This classification nearly includes all mechanical eye injuries to makes epidemiological study and clinical records easier.

REFERENCES 1. Wong TY, Klein BE, Klein R. The prevalence and 5-year incidence of ocular trauma. The

Beaver Dam Eye Study. Ophthalmology. 2000; 107:2196-202.2. Negrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiology.

1998;5:143-69.3. Alfaro DV 3rd, Jablon EP, Rodriguez Fontal M, Villalba SJ, Morris RE, Grossman M, Roig-Melo

E. Fishing-related ocular trauma. Am J Ophthalmol. 2005 Mar;139(3):488-92.4. Kuhn F, Morris R, Witherspoon CD, Mester V, The Birmingham Eye Trauma Terminology

system (BETT). J Fr Ophtalmol. 2004;27:206-10.5. Rofail M, Lee GA, O’Rourke P: Prognostic indicators for open globe injury. Clin Experiment

Ophthalmol 2006;34:783–786.6. Rahman I, Maino A, Devadason D: Open glob injuries: Factors predictive of poor outcome.

Eye 2006;20:1336-1341.