General Principles of Eye Trauma Classification
In medical practice, eye injuries are categorized according to several key criteria.
Based on the damaging factor, they are divided into mechanical (including wounds and contusions), thermal (burns or frostbite), chemical (with contact or resorptive effect), and radiation injuries.
Injuries are classified by the circumstances of occurrence: occupational, domestic, sports-related, traffic accidents, as well as specific types such as combat injuries and injuries resulting from environmental disasters (emergencies).
An important criterion is the localization of the pathology. The eyeball itself (corneal, scleral, or limbal defects), the orbit, or the adnexa may be damaged. Combined variants are common.
Special attention is paid to the severity degree: from mild to extremely severe. This indicator is dynamic in nature — the severity assessed upon admission may be revised during or after the completion of therapy.
International Ocular Trauma System (ISOT)
The fundamental criterion of modern practical classification is the integrity of the fibrous tunic of the eye. It is evaluated whether it is damaged through its entire thickness. Based on this, two major classes are distinguished.
Closed globe injury (CGI) includes contusions, as well as non-perforating wounds (including those with superficial foreign body embedding).
Open globe injury (OGI) is subdivided into five types:
- Type A — globe rupture resulting from a contusion (full-thickness wound caused by a blunt object).
- Type B — penetrating wound caused by a sharp object (no retained intraocular foreign body).
- Type C — localized penetrating injury with a retained intraocular foreign body.
- Type D — perforating wound (double penetration with entry and exit openings).
- Type E — difficult-to-classify mixed defects (e.g., in severe polytrauma with total destruction of the globe).
Injuries of the Orbit and Its Soft Tissues
Orbital injuries are extremely diverse due to a multitude of mechanisms (falls, blunt or sharp trauma, gunshot wounds). They can be isolated or combined (involving the paranasal sinuses and brain).
The clinical presentation of orbital wall fractures directly depends on their severity. Subjectively, the patient experiences pain, diplopia (which appears almost immediately and persists for a long time), and blurred vision against the background of shock. Objectively, the physician notes hematoma and eyelid edema, narrowing of the palpebral fissure, ptosis, limitation of ocular motility, enophthalmos (enophthalmos) or protrusion (exophthalmos). Subcutaneous emphysema frequently occurs.
Soft tissue wounds of the orbit are divided into incised, stab, and lacerated wounds. Lacerated wounds have distinct specific features: they are characterized by prolapse of orbital adipose tissue, damage to the lacrimal gland, and extraocular muscles. This is accompanied by ophthalmoplegia and drooping of the upper eyelid.
Internal Bleeding in Polytrauma
Traumatology closely intersects with other medical disciplines (neurosurgery, otorhinolaryngology). Severe facial trauma is often accompanied by occult injuries to other systems without violation of the integument. Detecting internal bleeding is significantly more difficult than external bleeding.
With the development of acute anemia syndrome (e.g., in splenic capsule rupture), a distinct symptom complex emerges. The patient complains of thirst, dizziness, drowsiness, and darkening before the eyes; fainting is possible. Examination reveals pallor of the skin and visible mucous membranes. Hemodynamics change dramatically: blood pressure drops (hypotension), and heart rate increases to 120–140 beats per minute. It is important to remember that with slow blood loss, symptoms develop gradually.
To memorize the types of open globe injury (ISOT): A (Accident/Blunt rupture), B (No foreign body), C (With foreign body), D (Double opening — perforating).
Class and exam questions
What is the basis for dividing mechanical eye injuries into open and closed?
The main criterion is the presence or absence of a full-thickness injury to the fibrous tunic of the eye (whether the wall is damaged through its entire thickness).
Can the severity of an injury change during treatment?
Yes, the classification by severity is dynamic. Initially established mild or moderate injuries may be reclassified into a more severe category over time.
What symptoms are most characteristic of an orbital wall fracture?
Patients complain of immediately occurring diplopia and pain. Objectively, limitation of ocular motility, subcutaneous emphysema, ptosis, enophthalmos or exophthalmos, and eyelid hematoma are revealed.
What else to study on this topic
- Topography of eyeball injuries: limbal, scleral, and corneal defects
- Features of injuries to the eye adnexa
- Diagnostics and clinical presentation of chemical burns with resorptive effects
- Thermal and radiation injuries of the visual system
- Algorithm for identifying internal bleeding in polytrauma
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