The Ocular Trauma Classification Group developed a classification system for mechanical injuries to the eye. It is based on the initial examination or evaluation at the time of primary surgical intervention. The OTC Group consists of 13 ophthalmologists from 7 medical institutions in the United States.
Class of injury:
(1) open-globe: injury with full thickness wound to the corneosclera
(2) closed-globe: injury without full thickness defect of the corneosclera
Components to classification:
(1) type
(2) grade based on visual acuity, using (a) a Snellen chart at 20 ft or 6 meters, or (b) a Rosenbaum near card with correction and pinhole, when appropriate
(3) defect in pupillary response to light stimulus
(4) zone affected
|
Type |
Open-Globe |
Closed-Globe |
|
A |
rupture |
contusion |
|
B |
penetrating |
lamellar laceration |
|
C |
intraocular foreign body |
superficial foreign body |
|
D |
perforating |
mixed |
|
E |
mixed |
N/A |
|
Visual Acuity |
Grade |
|
>= 20/40 |
1 |
|
20/50 to 20/100 |
2 |
|
19/100 to 5/200 |
3 |
|
4/200 to light perception |
4 |
|
no light perception |
5 |
|
Relative Afferent Pupillary Defect |
Response |
|
present in the affected eye |
positive |
|
absent in the affected eye |
negative |
Assessing the pupillary response:
(1) The testing is done with the swinging flashlight test.
(2) If the injured eye is mechanically or pharmacologically nonreactive, or if there is a media opacity, then a consensual response in the fellow eye is considered negative. If the person is mono-ocular, then the component cannot be assessed.
(3) If the patient has bilateral fixed or unreactive pupils, then this component cannot be assessed.
|
Zone |
Open-Globe (location of the most posterior full-thickness aspect of the globe opening) |
Closed-Globe (based upon the anatomic location of the injury) |
|
I |
isolated to cornea (including the corneoscleral limbus) |
external (limited to bulbar conjunctiva, sclera, cornea) |
|
II |
corneoscleral limbus to a point 5 mm posterior into the sclera |
anterior segment |
|
III |
posterior to the anterior 5 mm of the sclera |
posterior segment |
where:
• The anterior segment involves structures in the anterior segment internal to the cornea and including the posterior capsule, as well as the pars plicata but not the pars plana.
• The posterior segment includes all internal structures posterior to the posterior lens capsule.
Specialty: Ophthalmology, Emergency Medicine, Surgery, general
