Ocular trauma, an evolving sub specialty.

Most of us commonly see patients with ocular trauma in our daily practice. This may range from a small foreign body on the cornea to a ruptured globe, from a patient presenting with 6/6 vision to a patient with no perception of light. All these patients get treated differently depending upon the part of the country and availability of medical support. All of us have different levels of involvement in treating them.

There have been numerous individual reports on ocular trauma. WHO has reported 55 million eye injuries causing restriction of daily activities, of which 1.6 million go blind every day.[1] Vats et al., have reported the prevalence of ocular trauma to be 2.4% of population in an urban city in India. 11.4% of these are blind.[2] In this issue there is an interesting article by Agarwal et al., on visual outcomes in patients with posterior open globe injury.

The other aspects that need attention include terminology and classification of ocular trauma [Figs 1 and 2]. Among the standard systems available, Birmingham Eye Trauma Terminology is the one most widely accepted.[3]

Figure 1

Present classification of Ocular trauma

Figure 2

General classification of Ocular trauma

There have also been numerous controversies with respect to classification. There have been classifications approved by International Society of Ocular Trauma, but these are limited to globe injuries and do not include injury to the orbit or adnexa.[3]

The classification proposed by Dr Shukla, which is approved by the Ocular Trauma Society of India (OTSI), is a comprehensive classification.

In spite of these numerous articles on ocular trauma, we still do not have any estimate of the actual prevalence of ocular trauma in India. The American Society of Ocular Trauma has a United States Eye Injury Registry and the International Society of Ocular Trauma has a World Eye Injury Registry. The Ocular Trauma Society of India has proposed an India Eye Injury Registry for the same. A registry would enable us to measure epidemiology, standardize and evaluation protocols, data collection for treatment outcomes, propose clinical trials, and disseminate information.

I would like to once again emphasis on the changing perspectives in ocular trauma and look at ocular trauma as an evolving separate sub-specialty.