Most eye health workers are involved in managing trauma. In fact, ocular injuries around the world make up a major part of daily ophthalmic clinical practice. Eye injuries range from mild, non sight-threatening, to extremely serious with blinding consequences

Patel, Daksha

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Eye injuries: improving our practice

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Patel, D (2015) Eye injuries: improving our practice. Communityeye health / International Centre for Eye Health, 28 (91). pp. 41-3.ISSN 0953-6833Downloaded from: http://researchonline.lshtm.ac.uk/3449756/DOI:Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna-tively contact researchonline@lshtm.ac.uk.Available under license: http://creativecommons.org/licenses/by/2.5/  COMMUNITY EYE HEALTH JOURNAL | VOLUME 28 ISSUE 91 | 2015  41 Community Eye Health JOURNALVOLUME 28 | ISSUE 91 | 2015Most eye health workers are involved in managing trauma. In fact, ocular injuries around the world make up a major part of daily ophthalmic clinical practice. Eye injuries range from mild, non sight-threat-ening, to extremely serious with blinding consequences.Epidemiology Epidemiological data on ocular trauma is limited. A review undertaken for the World Health Organization (WHO) in 19981 estimated that injuries were responsible for the following:• 1.6 million people blind in both eyes• 2.3 million people with low vision in both eyes• 19 million people blind in one eye • 55 million people with eye injuries that resulted in restricted activities for more than one day a year.The demographic pattern (age/gender) of ocular injuries varies with the environment and cause of injury. The general pattern is that of a curve with two peaks: one in the age group 5–25 years and another in people aged 70 years and over. Compared to women, the risk of eye injuries in men is four times higher. Accurate data – essential for guiding management and prevention – has been difficult to record or compare, due to a number of factors.• The different environments in which injuries occur• The wide range of causes • The wide spectrum of clinical (anatomical) presentations • Different data sources, e.g. hospital discharge data, out-patient visits• The lack of a widely used standardised template for reporting injuries.Assessment and the BETTS ClassificationThe introduction of the Birmingham Eye Trauma Terminology System (BETTS)2 in early 2000 provided a standardised and simple system to describe mechanical injuries to the eye globe. The panel on page 43 provides an outline of this classi-fication, which is applicable to clinical practice and can also be used to audit and create an appropriate registry for injuries. In this issue we look at how BETTS is used to guide the clinician in management. In all eye trauma cases, the main concern of patients and their families is the visual prognosis. To address this, the Ocular Trauma Score (OTS) has been developed; it is based on the BETTS classification system and is used to calculate prognosis (with the assumption Faustin Ngounou Eye injuries: improving our practiceThis issue of the Community Eye Health Journal is about eye injuries, including approaches for prevention and tips on how to assess, classify and manage them. Eye injuries affect people, not just eyes. People with eye injuries are in pain and have been through what was very likely a terrifying experience for them; they will also be anxious about their vision. We explain how to reassure and support patients, despite the difficult circumstances in which they find themselves. We also introduce the Ocular Trauma Score (OTS), based on the BETTS classification, which is there to help clinicians estimate the visual prognosis of an eye injury and guide referrals. It is particularly helpful when talking to patients and their family members about what to expect. The OTS isn’t perfect, however – it is correct 4 times out of 5 which means that clinicians must always apply their best clinical judgement when using it. Also, the OTS is only valid if the eye injury has been managed correctly. We hope that our article on the management of injuries will provide useful reminders. Enjoy the issue! ABOUT THIS ISSUEContinues overleaf ➤A 10-year-old with corneal laceration and traumatic cataract after a stone hit him in the eye. CAMEROONDaksha PatelE-learning Director: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.42   COMMUNITY EYE HEALTH JOURNAL | VOLUME 28 ISSUE 91 | 201541 Eye injuries: improving our practice44 The Ocular Trauma Score (OTS)45 Implementing and applying the Ocular Trauma Score: the challenges46 Assessing an eye injury patient48 Managing eye injuries50 Talking with eye injury patients51 Prevention of ocular injuries52 Challenges of agriculture-related eye injuries in Nigeria53 Preventing eye injuries in quarries54 REFRACTIVE ERROR UPDATE Improving access to refractive and eye health services 55 ICEH UPDATE 56 CATARACT SERIES A ‘health system’ perspective on scaling up hospital cataract services 57 EQUIPMENT CARE AND MAINTENANCE Caring for A- and B-scans58 TRACHOMA UPDATE59 CPD QUIZ60 NEWS AND NOTICES“Improving eye health through the delivery of practical high-quality information for the eye care team” Volume 28 | ISSUE 91Supporting VISION 2020: The Right to Sight  COMMUNITY EYE HEALTH JOURNAL | VOLUME 28 ISSUE 91 | 2015  41 Community Eye Health JOURNALVOLUME 28 | ISSUE 91 | 2015Most eye health workers are involved in managing trauma. In fact, ocular injuries around the world make up a major part of daily ophthalmic clinical practice. Eye injuries range from mild, non-sight threat-ening to extremely serious with blinding consequences.Epidemiology Epidemiological data on ocular trauma is limited. A review undertaken for the World Health Organization (WHO) in 19981 estimated that injuries were responsible for the following:• 1.6 million people blind in both eyes• 2.3 million people with low vision in both eyes• 19 million people blind in one eye • 55 million people with eye injuries that resulted in restricted activities for more than one day a year.The demographic pattern (age/gender) of ocular injuries varies with the environment and cause of injury. The general pattern is that of a curve with two peaks: one in the age group 5–25 years and another in people aged 70 years and over. Compared to women, the risk of eye injuries in men is four times higher. Accurate data – essential for guiding management and prevention – has been difficult to record or compare, due to a number of factors.• The different environments in which injuries occur• The wide range of causes • The wide spectrum of clinical (anatomical) presentations • Different data sources, e.g. hospital discharge data, out-patient visits• The lack of a widely used standardised template for reporting injuries.Assessment and the BETTS ClassificationThe introduction of the Birmingham Eye Trauma Terminology System (BETTS)2 in early 2000 provided a standardised and simple system to describe mechanical injuries to the eye globe. The panel on page 43 provides an outline of this classi-fication, which is applicable to clinical practice and can also be used to audit and create an appropriate registry for injuries. In this issue we look at how BETTS is used to guide the clinician in management. In all eye trauma cases, the main concern of patients and their families is the visual prognosis. To address this, the Ocular Trauma Score (OTS) has been developed; it is based on the BETTS classification system and is used to calculate prognosis (with the assumption Faustin Ngounou Eye injuries: improving our practiceThis issue of the Community Eye Health Journal is about eye injuries, including approaches for prevention and tips on how to assess, classify and manage them. Eye injuries affect people, not just eyes. People with eye injuries are in pain and have been through what was very likely a terrifying experience for them; they will also be anxious about their vision. We explain how to reassure and support patients, despite the difficult circumstances in which they find themselves. We also introduce the Ocular Trauma Score (OTS), based on the BETTS classification, which is there to help clinicians estimate the visual prognosis of an eye injury and guide referrals. It is particularly helpful when talking to patients and their family members about what to expect. The OTS isn’t perfect, however – it is correct 4 times out of 5 which means that clinicians must always apply their best clinical judgement when using it. Also, the OTS is only valid if the eye injury has been managed correctly. We hope that our article on the management of injuries will provide useful reminders. Enjoy the issue! ABOUT THIS ISSUEContinues overleaf ➤A 10-year-old with corneal laceration and traumatic cataract after a stone hit him in the eye. CAMEROONDaksha PatelE-learning Director: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.EditorElmien Wolvaardt Ellison editor@cehjournal.orgEditorial committeeAllen FosterClare GilbertNick AstburyDaksha PatelRichard WormaldMatthew BurtonHannah KuperPriya MorjariaG V MurthyFatima KyariDavid YorstonSally CrookSerge ResnikoffBabar QureshiPeter AcklandJanet MarsdenNoela PrasadRegional consultantsHugh Taylor (WPR) Leshan Tan (WPR)GVS Murthy (SEAR)R Thulsiraj (SEAR)Babar Qureshi (EMR)Mansur Rabiu (EMR)Hannah Faal (AFR)Kovin Naidoo (AFR) Ian Murdoch (EUR)Janos Nemeth (EUR)Van Lansingh (AMR)Andrea Zin (AMR)that the trauma is managed optimally).  On page 44 we introduce the OTS and demonstrate how it may be used. Prevention and management In general, it seems that people assume that eye injuries are the result of ‘accidents’, i.e. that they are outside of human control. It is not always the case – eye injuries are often preventable. This assumption might go some way towards explaining why, in many countries, not much attention has been given to the development of strategies for eye injury prevention.  The first step in prevention is to under-stand the local causes of eye injuries, and their patterns. This is why it is important to establish a local injuries register that uses the BETTS classification system and includes age, gender, place and cause of injury. This evidence can guide the development of local prevention inter-ventions, such as protective eyewear in the workplace, legislation and enforcement about the use of seat belts, and first aid management of agricultural eye trauma. Data will also be comparable with other regions and other countries.In many low- and middle-income countries, trauma cases are often complicated by late presentation and/or previous inappropriate intervention. To have a well-trained first contact person at the primary level is therefore critical for the correct assessment and management of an eye injury.ConclusionFrom a public health perspective, neither bilateral nor unilateral blindness data provide a complete picture of the impact of ocular trauma on society. Severe ocular trauma requires expensive hospitalisation and specialist treatment, and often prolonged follow-up and visual rehabilitation. This has significant economic costs for the patient and the health service. It is therefore very important to better under-stand the local patterns of ocular injuries (through accurate data collection) and to develop appropriate prevention and management strategies. References1 Négrel A, Thylefors B. Review article The global impact of eye injuries. 1998;5(3). 2 Kuhn F, Morris R, Witherspoon CD, Mester V. The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol [Internet]. 2004;27(2):206–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15029055‘The first step in prevention is to understand the local causes of ocular injuries and their patterns’Editorial assistant Anita ShahDesign Lance BellersProofreading Jane TrickerPrinting Newman ThomsonCEHJ onlineVisit the Community Eye Health Journal online. All back issues are available as HTML and PDF. Visit: www.cehjournal.orgOnline edition and newsletter Sally Parsley: web@cehjournal.orgConsulting editor for Issue 91Daksha PatelPlease support usWe rely on donations/subscriptions from charities and generous individuals to carry out our work. We need your help. Subscriptions in high-income countries cost UK £100 per annum.Contact Anita Shah admin@cehjournal.org  or visit the journal website: www.cehjournal.org/donateSubscriptions Readers in low- and middle-income countries get the journal free of charge. Send your name, occupation, and postal address to the address opposite. French, Spanish, and Chinese editions are available. To subscribe online, visit www.cehjournal.org/subscribe Address for subscriptionsAnita Shah, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.Tel +44 (0)207 958 8336 Email admin@cehjournal.orgCorrespondence articlesWe accept submissions of 800 words about readers’ experiences. Contact:  Anita Shah: correspondence@cehjournal.org© International Centre for Eye Health, London. Articles may be photocopied, reproduced or translated provided these are not used for commercial or personal profit. Acknowledgements should be made to the author(s) and to Community Eye Health Journal. Woodcut-style graphics by Victoria Francis and Teresa Dodgson.ISSN 0953-6833DisclaimerSigned articles are the responsibility of the named authors alone and do not necessarily reflect the views of the London School of Hygiene & Tropical Medicine (the School). Although every effort is made to ensure accuracy, the School does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the School in preference to others of a similar nature that are not mentioned. The School does not endorse or recommend products or services for which you may view advertisements in this Journal.© The author/s and Community Eye Health Journal 2015. This is an Open Access article distributed under the Creative Commons Attribution Non-Commercial License.

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