Open Globe Management

Alessandro A. Castellarin, MD; Dante J. Pieramici, MD


Compr Ophthalmol Update. 2007;8(5):111-124. 

In This Article

Prognostic Factors in Open Globe Injuries

The prognosis of an open globe injury is variable. Visual acuity on presentation is probably the best predictor of final visual acuity. However, even eyes presenting with no light perception vision might end up with useful vision, and poor vision alone should not be used as a reason to forgo primary or secondary repair of the severely injured eye. A review of the USEIR database revealed that 13% of patients presenting with no light perception vision actually achieved some level of measurable vision during follow-up.[48] The presence of afferent pupillary defect on presentation is also a poor prognostic sign.[49] Multivariate analysis of a system for the classification of eye injuries found that the presenting visual acuity and the presence or absence of an afferent pupillary defect in the injured eye were the most important prognostic factors. Other clinical signs associated with poor visual acuity include large (> 10 mm) lacerations, scleral lacerations posterior to the insertion of the rectus muscle, vitreous hemorrhage, and retinal detachment.[50,49] Perforating injuries and presence of IOFB have also been correlated with poor outcome.[51,52]

In case of a severe eye injury, it is important to provide the patient with reliable information regarding the expected outcome of the injury. As a rule of thumb, visual acuity at the time of presentation is the best predictor of final visual acuity. The Ocular Trauma Score (OTS) has been developed using combined data from the USEIR and the HEIR, and provides the ability to prognosticate the outcome of the injury ( Table 1 and Table 2 ). The OTS uses a limited number of variables and basic mathematics to give the ophthalmologist a 77% chance to predict the final functional outcome.[53]


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