Ment maculopathy In such cases the worst injury type rupture in this example is the one that best describes the consequences and implications of the case

Table 1.1.3 Terms and definitions in BETT

Term

Definition

Comment

Eye wall

Sclera and cornea

Though the eye wall has three layers posterior to the limbus, clinical and practical purposes dictate that violation of only the most external tissue (sclera) is to be considered

Closed globe injury

No full-thickness wound of eye wall

The cornea and the sclera are not breached through and through

Open globe injury

Full-thickness wound of the eye wall

The cornea and/or sclera is breached through and through

Contusion

No wound of the eye wall

The damage may be due to direct energy delivery/shock wave by the object (e.g., choroidal rupture), or to changes in the shape of the globe (e.g., angle recession)

Lamellar laceration

Partial-thickness wound of the eye wall

The wound in the eye wall is not "through" but "into"

Rupture

Full-thickness wound of the eye wall, caused by a large blunt object

Since the eye is filled with incompressible liquid, the impact results in instant IOP elevation. The eye wall yields at its weakest point (rarely at the impact site, rather, for instance, along an old cataract wound); the actual wound is produced by an inside-out mechanism, and tissue prolapse is almost unavoidable

Some injuries have a complex mechanism and are thus difficult to classify (e.g., an intravit-real BB pellet is technically an IOFB injury, but since this blunt object requires great force to enter the eye, the wound is created as if it were a rupture; see the text for more details). In such situations, the ophthalmologist can describe the injury as "mixed" (i.e., rupture with an IOFB) and select the more serious type (rupture), or the one that dominates the acute management (IOFB). Complete destruction of the eye and traumatic enucleation (see Fig. 1.1.5) are not included in the system

Table 1.1.3 (continued) Terms and definitions in BETT

Term

Definition

Comment

Laceration

Full-thickness wound of the eye wall, caused by a sharp object

The wound is at the impact site and is created by an outside-in mechanism; since IOP elevation is unavoidable, tissue prolapse is common

Penetrating injury

An entrance wound is present

If more than one wound is present, each must have been caused by a different object

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