A system for classifying mechanical injuries of the eye

Purpose. Current clinical and research assessment of mechanical ocular injuries lacks standardization of terminology usage and systematic injury classification. We propose a system for classifying mechanical ocular trauma for open and closed globe injuries. Methods. A committee was organized to discuss and design a classification system for use by ophthalmologists who care for and/or conduct research on ocular injuries. This system is based on both anatomic and physiologic parameters that previous studies have found to be prognostic of visual outcome for these types of injuries. In addition, the parameters chosen were those that could be assessed clinically on presentation or during the initial surgical procedure without the need for extraordinary testing. Results. A separate grading/staging system is proposed for open and closed globe injuries respectively. Each classification system is based on four specific parameters of ocular trauma anatomy or physiology; (1) Type or mechanism of injury; for open globe injuries the types included: a) Rupture b) Penetrating c) Intraocular foreign body d) Perforating e) Mixed; for closed globe injuries they included: a) Contusion b) Lamellar Lacerations c) Mixed, (2) Grade of injury, defined by the presenting visual acuity, (3) Zone of injury, defined by the posterior extent of the globe opening in open globe injuries or the most posterior ocular structure involved in non open globe injuries, (4) and "Plus Disease" defined as the presence of an afferent pupillary defect in the involved eye. Conclusions. This classification system should be both descriptive and prognostic for open and closed globe injuries, with immediate clinical and research applications.