Chapter 1

BETT: THE TERMINOLOGY OF OCULAR TRAUMA

Ferenc Kuhn, Robert Morris, and C. Douglas Witherspoon

CURRENT PROBLEMS

Trauma can result in a wide spectrum of tissue lesions of the globe, optic nerve, and adnexa, ranging from the relatively superficial to vision threatening. Our understanding of the pathophysiology and management of these disorders has advanced tremendously over the last 30 years, and it is critical that a standardized classification system of terminology and assessment be used by both ophthalmologists and non-ophthalmologists when describing and communicating clinical findings. A uniform classification system enables this accurate transmission of clinical data, facilitating the delivery of optimal patient care as well as further analysis of the efficacy of medical and surgical interventions.

Without a standardized terminology of eye injury types, it is impossible to design projects such as the development of the OTS, to plan clinical trials in the field of ocular trauma, and to communicate unambiguously between ophthalmologists. Multiple examples from the literature demonstrate the lack of definitions, with obvious implications.

Blunt injury

• If the consequences are blunt, it is a contusion (closed globe injury).¹

• If the inflicting object is blunt, it is either a contusion or a rupture (open globe injury).² To add to the confusion, the two terms have even been thrown together as contusion rupture.³ Because the word “blunt” is ambiguous and contusion and rupture have vastly different implications, it is best to eliminate “blunt” from the eye injury vocabulary.

Blunt nonpenetrating globe injury³

• Do sharp nonpenetrating injuries also occur?

Blunt penetrating trauma⁴

• Aren’t all penetrating injuries sharp?

Sharp laceration⁵

• Is there a laceration that is blunt?

Blunt rupture⁶

• Is there a rupture that is sharp?

An unambiguous system in ocular traumatology must satisfy the following three criteria.

1. Each term has a unique definition. Currently, it is exceptional that definitions in publications are provided at all or that their use is enforced.⁷

2. No term can be applied for two different injuries. Unfortunately, numerous examples show that the same term is used to describe two distinctly different clinical entities. For example, perforating can mean an injury with an entrance wound only⁸ or one with both an entrance and an exit wound.⁹

3. No injury is described by different terms. Unfortunately, numerous examples show just the opposite. For example, an injury with both entrance and exit wounds is referred to as double penetrating,¹⁰ double perforating,¹¹ and perforating,¹² or the same injury is alternatively referred to either as penetrating or as perforating even within the same article.¹³

BIRMINGHAM EYE TRAUMA TERMINOLOGY^a

BETT satisfies all criteria for unambiguous standard terminology by:

• providing a clear definition for all injury types (Table 1–1); and

• placing each injury type within the framework of a comprehensive system (Fig. 1–1).

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