|
|
Trauma Terminology System (BETTS)
BETTS, a comprehensive, standardized
system of eye trauma terms,
should be utilized when reporting to
USEIR.
| BETTS, has been endorsed by the: |
BETTS it is mandated by: |
| > American Academy of Ophthalmology |
> Graefe's Archives |
| > International Society of Ocular Trauma |
> Klinische MonatsblŠtter |
| > Retina Society |
> Ophthalmology |
| > United States Eye Injury Registry |
|
| > Vitreous Society |
|
| > World Eye Injury Registry |
|
BETTS
Glossary of Terms
|
Term |
Definition
and explanation |
| Eyewall |
Sclera and cornea.
| Though technically the eyewall has three
coats posterior to the limbus, for clinical and practical purposes
violation of only the most external structure is taken into
consideration |
|
| Closed globe injury |
No full- thickness wound of eyewall. |
| Open globe injury |
Full- thickness wound of the eyewall. |
| Contusion |
There is no (full- thickness) wound.
| The injury is either due to direct energy
delivery by the object (e. g., choroidal rupture) or to the
changes in the shape of the globe (e. g., angle recession) |
|
| Lamellar laceration |
Partial- thickness wound of the eyewall. |
| Rupture |
Full- thickness wound of the eyewall, caused by a
blunt object.
| Since the eye is filled with incompressible
liquid, the impact results in momentary increase of the IOP.
The eyewall yields at its weakest point (at the impact site or
elsewhere; example: an old cataract wound dehisces even
though the impact occurred elsewhere); the actual wound is
produced by an inside- out mechanism |
|
| Laceration |
Full- thickness wound of the eyewall, caused by a
sharp object.
| The wound occurs at the impact site by an
outside- in mechanism |
|
| Penetrating injury |
Entrance wound.
| If more than one wound is present,
each must have been caused by a different agent |
|
| Retained foreign object/ s. |
| Technically a penetrating injury, but
grouped separately because of different clinical
implications |
|
|
| Perforating injury |
Entrance and exit wounds.
| Both wounds caused by the same agent |
|
*Some injuries remain difficult to classify. For instance, an intravitreal
BB pellet is technically an IOFB injury. However,
since this is a blunt object that requires a huge impact force if they
enter, not just contuse, the eye, there is an element of
rupture involved. In such situations, the ophthalmologist should either
describe the injury as "mixed" (i. e., rupture with
an IOFB) or select the most serious type of the mechanisms involved.
Discussion
Worldwide interest in ocular
trauma is rapidly growing as increasingly effective techniques for
prevention and treatment are developed. Professional associations
(International Society of Ocular Trauma,
United States Eye Injury Registry) have been formed to promote research
and disseminate its results.
Unfortunately, the lack of an unambiguous common language remains a major
limiting factor in effectively
sharing eye injury information: varying responses are given to simple
questions such as What is the distinction
between laceration, rupture, penetration, and perforation? Is a full-
thickness scleral wound without obvious choroidal and retinal involvement
an open globe injury? If a foreign body has traversed the eye and lodged
in the orbit, is it perforating? double perforating? double
penetrating? ).
Despite these ambiguities,
whether publishing in a peer- review journal or discussing patient
referral over
the telephone, ophthalmologists continue to use certain ocular trauma
terms, rather than lengthy descriptions, to
characterize the eye's condition. Our colleagues definition and
understanding of these terms are assumed
identical to ours with each term having a definition which is unambiguous
and independent of such variables as
time, individuality, geographical location, and place of training. It is
also commonly assumed that a one- to- one
relationship between condition and term exists: there is no condition
which can alternatively be described by
more than a single term, and there is no term characterizing more than a
single clinical condition. Unfortunately,
our review of scientific journals and reference books proved these
assumptions to be incorrect.
Without a standardized terminology of eye injury types, it is
impossible to design projects like the United
States Eye Injury Registry (USEIR) or the World Eye Injury Registry
(WEIR); clinical trials in the field of ocular
trauma cannot be planned; and the communication between ophthalmologists
remains ambiguous. A
standardized terminology for eye injury has been developed based on
extensive experience. It has then
undergone repeated reviews by international ophthalmic audiences,
incorporating suggestions from
respondents in 13 countries and selected ocular trauma experts. By always
using the entire globe as the tissue of
reference, classification is unambiguous, consistent, and simple. It
provides definitions for the commonly used
eye trauma terms within the framework of a comprehensive system.
BETTS
BETTS satisfies all criteria by:
> providing a clear definition for all injury types (Table 1) and
> placing each injury type within the framework of a comprehensive
system (Fig. 1). The key to BETTS' logic is to
understand that all terms relate to the whole eyeball as the tissue of
reference . While in BETTS, a " penetrating corneal injury"
is unambiguously an open globe injury with a corneal wound, the
same term had two potential meanings before:
> an injury penetrating into the cornea (i. e., a partial- thickness
corneal wound: a closed globe injury) or
> an injury penetrating into the globe (i. e., a full- thickness
corneal wound: an open globe injury).
|
