|Year : 1983 | Volume
| Issue : 4 | Page : 439-441
Trauma index-a system of evaluation of ocular damage due to trauma
B Shukla, Binoo Khanna
Department of Ophthalmology G.R. Medical College, Gwalior, India
Department of Ophthalmology G.R. Medical College, Gwalior
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shukla B, Khanna B. Trauma index-a system of evaluation of ocular damage due to trauma. Indian J Ophthalmol 1983;31:439-41
|How to cite this URL:|
Shukla B, Khanna B. Trauma index-a system of evaluation of ocular damage due to trauma. Indian J Ophthalmol [serial online] 1983 [cited 2020 Jun 1];31:439-41. Available from: http://www.ijo.in/text.asp?1983/31/4/439/27574
Ocular injuries are very common and are of great variety and complexity. Besides structural and functional loss they have social, occupational and medico-legal implications. Eye ball and its adnexa is a closely linked congregation of many delicate tissues which are affected in a variety of ways to various degrees. Hence it is by no means easy to make an over all assessment of a given case of ocular trauma. Time factor adds to further complexities. In most cases maximum damage occurs at the time of trauma which tends to return to normal with variable rate for variable period of time. However in some cases the effects have a late onset and need a long follow up.
Basically the magnitude of trauma depends on the structural and functional loss it induces. This loss has to be weighed against the time factor which implies approximate recovery time if at all. Based on these conceptions a formula for over all assessment of ocular injury has been worked out and is named Trauma Index.
Trauma Index (T.I.;= 1/2 (S/2 + F) x T/ 100
S - stands for structural loss and is graded as mild (25%), moderate (50%) and marked (100%). Marked loss includes cases of large scleral or corneo-scleral tears, total anterior staphyloma, phthisis bulbi, multiple fractures leading to gross displacement of the globe. Moderate loss included dense corneal and lenticular opacities, ptosis or lagophthalmos, squint, marked subconjunctival haemorrhages and hyphaema and acute inflammations. Mild loss included slight corneal and lenticular opacities, scar or notching of lids, slight congestion, swelling, haemorrhage etc. One can not have water tight compartment in this grading and the judgement of the clinician is important.
F - stands for functional loss and is graded from 0 the 100% depending on the visual acuity (6/6 to No P.L.). The vision has been graded on percentage basis and the following table has been slightly modified from that given by Dhanda and Kalevar.
As is evident loss upto 6/60 is graded in steps of 10 and beyond that in steps of 5. This table is based on the presumption that pre-trauma vision was 6/6 which is perhaps true in most cases of young patients. However if the initial vision was low the difference from pre-trauma vision to post-trauma vision was taken for calculation where ever possible.
Although the structure and function of the eye are almost equally important but from the economical, occupational and medicolegal point of view the loss of function has much greater significance than the loss of structure alone. Hence in evaluation of trauma the structural loss has been halved in calculation.
In the formula for Trauma Index T stands for the time factor which indicates approximate time for recovery. It has been graded on percentage basis in the following table :
| Observations|| |
500 cases of eye injuries were studied at J.A. Hospital, Gwalior during the last 21/2 years (1.1.1979 to 30.6.1982). Besides detailed history, thorough clinical examination and pertinent investigations Trauma Index was calculated in each case by the formula mentioned earlier i.e. T.I. 1/2 (S/2 + ) x T/100
To simplify the evaluation further the ocular injuries were classified in three grade, depending on the Trauma Index as follows: -
Thus ocular injuries can be classified a: mild, moderate or severe based on quantitative estimation rather than on pure clinical assessment.
| Discussion|| |
Although many authors have anlaysed eases of ocular injuries,, there has been little effort so far to evaluate a given case of ocular trauma in a comprehensive way. Pritikin has mentioned an elaborate formula to estimate visual loss for compensation as practiced in the United States. Bhatt has graded them on the basis of visual loss.
We have made an affort to assess each case on the basis of structural loss and function loss in relation to time, and called it Trauma Index. While making calculations both the eyes are considered separately and adequate weightage is given to bilateral cases.
As evident from [Table - 3], out of 500 cases 187 (37%) had Trauma Index upto 10 only indicating that a great majority of injurses are mild and recover in short time. However 23.4% cases had Trauma Index over 50 indicating grave damage with poor recovery. At present at many places compensation in industrial injuries is given on a gross assessment of vision. Calculation of Trauma Index will provide a fairly accurate estimation of loss of structure and function and the quantum of compensation can be directly proportional to Trauma Index which would be more fare to employer and employee alike.
Similarly in medico-legal cased classification in terms of simple or grievous injury is not adequate. Trauma Index will provide the exact damage occured and claims can be made on more specific grounds and better justice can be delivered.
We have only tried to introduce this concept which has many potentialities. For example it could be worked out in relation to age, sex, occupation, nature and type of injury which would yield useful information and would help us to formulate ruo strategy for the prevention of ocular trauma.
| Acknowledgement|| |
We wish to thank Prof. S P. Srivastava and all the members of the Eye Department, J.A. Hospital, Gwalior for their help and encouragement.
| References|| |
Malik, S.R.K. et al, 1968,: J. All Ind. Ophthalmol. Soc., 16:178.
Shukla, LM. and Venna, E.N., 1979, Ind. J. Ophthalmol, 1:93.
Sofat, B.K.:1973 East. Arch. Ophthalmol, 6 : 391.
Pritikin R.T., 1968, J. All Ind, Ophthalmol. Soc, 16:240.
Bhatt, M.K., 1978, Study of pattern of ccular injuries. Thesis for M.S. Ophthal., Jiwaji Univ.
[Table - 1], [Table - 2], [Table - 3]