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Madigan Eye and Orbit Trauma Scale

Purpose: To evaluate a patient with trauma to the eye or orbit using the Madigan Eye and Orbit Trauma Scale (MEOTS).

Description

The Madigan Eye and Orbit Trauma Scale (MEOTS) can be used to grade trauma to the eye and orbit. This can help identify patients who may require urgent diagnosis and treatment. The scale was developed at the Madigan Army Medical Center in Tacoma, Washington.


Parameters:

(1) vision

(2) eyeball structure

(3) proptosis ("bulging")

(4) pupils and the pupillary reaction to light

(5) ocular motility

 

Parameter

Finding

Points

vision

small print (20/40)

3

 

large print (20/100)

2

 

count fingers

1

 

unable to count fingers

0

eyeball structure

intact

3

 

low suspicion for structural violation

2

 

high suspicion for structural violation

1

 

gross structural violation

0

proptosis

none

2

 

1 - 3 mm

1

 

> 3 mm, with orbit tense

0

pupils and reaction to light

equal and react to light

2

 

unequal

1

 

dilated (definite afferent pupillary defect)

0

ocular motility

normal

2

 

double vision

1

 

restricted motion

1

 

eyeball "frozen" (barely moves)

0

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 12

• A score <= 6 indicates a need for urgent treatment to preserve sight in the affected eye.

• A score > 6 may be associated with a blinding injury (I would imagine the risk of this is low for a score of 12).

 

Additional criteria for urgent referral, CT scanning and/or treatment:

(1) vision level at counting fingers level or less

(2) high suspicion or obvious violation of the globe (apply shield and give prophylactic antibiotics)

(3) proptosis of any degree

(4) dilated pupils with definite afferent pupillary defect

(5) double vision or restricted eyeball motility


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Specialty

Objective

ICD-10