Definition and comment

Closed globe injury

There is no full-thickness wound on the eyeball (sclera and cornea)

Lamellar laceration

Partial-thickness wound of the eyeball. The wound is just “into” rather than “through”


No full-thickness wound of the eyeball. The ocular contusions result from blunt energy delivered directly by some objects (like a fist, balls, doors, stone, or falling on the floor) or shock wave from them. The blunt trauma induces deformation of the globe, which causes the severe traction to the intraocular structures and rupture of tissues, bleeding (e.g., hyphema), and dislocation of normal structures (e.g., angle recession)

Open globe injury

There is at least one wound of full thickness on the eyeball (sclera and cornea)


Full-thickness wound of the eyeball is due to blunt energy caused by some blunt object. The blunt force exerts significant impact on the globe resulting in the temporary increase of intraocular pressure, which causes the global rupture at its weakest points (e.g., impact site or limbus). The mechanism of the rupture is actually caused by an inside-out force


Full-thickness wound occurs at the impact site caused by a sharp agent, in which an outside-in mechanism is involved

Penetrating injury

Injury of the eyeball has an entrance, but no exit, accompanied by the foreign body retained in the globe. If there are over one wound appeared, each of them must be induced by different objects


Injury with one or more than one foreign agent present in the globe, which technically occurs along with the penetrating injury, not separately

Perforating injury

Injury of the eyeball has both entrance and exit caused by the same object

Reprinted with permission from Kuhn [2]


Fig. 1.1
BETT. The bold boxes show the diagnoses that are used in clinical practice (Reprinted with permission from Kuhn [2])


Fig. 1.2
Classification of mechanical eye injuries in BETT used for clinical guidance (Reprinted with permission from Kuhn [2])

Using BETT in ocular traumatology is a mandatory standard to keep unambiguity among the healthcare professionals, without consideration of confusions caused by the communications.

1.4 Classification of Ocular Trauma

In ocular trauma classification developed by the Ocular Trauma Classification Group, mechanical trauma to the eyes is divided into open and closed globe injuries (Table 1.2) [3]. Four separate elements are under consideration: type, grade, presence/absence of a relative afferent pupillary defect (RAPD), and extent of the injury. This classification system will categorize ocular injuries as soon as the ophthalmologists start the initial examination. It is designed to promote the use of standard terminology and assessment, with applications to clinical management and research studies regarding eye injuries [4, 5].

Table 1.2
Ocular trauma classification system (OTCS)

Open globe injury classification

Close globe injury classification




Intraocular foreign body




Lamellar laceration

Superficial foreign body


Visual acuitya

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Sep 25, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Introduction

Full access? Get Clinical Tree

Get Clinical Tree app for offline access