• Qamar ul Islam PNS Shifa Naval Hospital
  • Mazhar Ishaq Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi
  • Muhammad Amer Yaqub Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi
  • Muhammad Asim Mehboob Registrar Ophthalmology, PNS Shifa Naval Hospital Karachi


Background: Prediction of final visual outcome in ocular injuries is of paramount importance and various prognostic models have been proposed to predict final visual outcome. The objective of this study was to validate the predictive value of ocular trauma score (OTS) in patients with combat related open globe injuries and to evaluate the factors affecting the final visual outcome. Methods: Data of 93 patients admitted in AFIO Rawalpindi between Jan 2010 to June 2014 with combat related open globe ocular injuries was analysed. Initial and final best corrected visual acuity (BCVA) was categorized as No Light Perception (NLP), Light Perception (LP) to Hand Movement (HM), 1/200-19/200, 20/200–20/50, and ≥20/40. OTS was calculated for each eye by assigning numerical raw points to six variables and then scores were stratified into five OTS categories. Results: Mean age of study population was 28.77±8.37 years. Presenting visual acuity was <20/200 (6/60) in 103 (96.23%) eyes. However, final BCVA of ≥20/40 (6/12) was achieved in 18 (16.82%) eyes, while 72 (67.28%) eyes had final BCVA of <20/200 (6/60). Final visual outcome in our study were similar to those in OTS study, except for NLP in category 1 (81% vs. 74%) and ≥20/40 in category 3 (30% vs. 41%). The OTS model predicted visual survival (LP or better) with a sensitivity of 94.80% and predicted no vision (NLP) with a specificity of 100%. Conclusion: OTS is a reliable tool for assessment of ocular injuries and predicting final visual outcome at the outset.Keywords: Ocular Trauma; Ocular Trauma Score (OTS); Open Globe Injury; Visual Acuity

Author Biographies

Qamar ul Islam, PNS Shifa Naval Hospital

Classified Eye Specialist / Asisstant ProfessorBahria University Medical & Dental CollegeConsultant Vitreo Retinal Surgeon

Mazhar Ishaq, Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi

Commandant AFIOAdvisor In Ophthalmology, Armed ForcesProfessor of Ophthalmology , Army Medical College

Muhammad Amer Yaqub, Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi

Consultant Orbital and Oculoplastic SurgeonProfessor of Ophthalmology , Army Medical College


Scott R. The injured Eye. Philos Trans R Soc Lond B Biol Sci 2011;366(1562):251–60.

Blanch RJ, Scott RA. Military ocular injury: presentation, assessment and management. J R Army Med Corps 2009;155(4):279–84.

Mansour AM, Zein WM, Sibai TA, Mehio-Sibai A, Ismail H, Orm SB. Comparison of Domestic and War Ocular Injuries during the Lebanese Civil War. Ophthalmologica 2009;223(1):36–40.

Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am 2002;15(2):139–43.

Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The ocular trauma score (OTS). Ophthalmol Clin North Am 2002;15(2):163–5.

Schmidt GW, Broman AT, Hindman HB, Grant MP. Vision Survival after Open Globe Injury Predicted by Classification and Regression Tree Analysis. Ophthalmology 2008;115(1):202–9.

Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, Bridges WZ Jr, Capone A Jr, Cardillo JA, et al. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group. Am J Ophthalmol 1997;123(6):820–31.

Unver YB, Kapran Z, Acar N, Altan T. Ocular Trauma Score in Open-Globe Injuries. J Trauma 2009;66(4):1030–2.

Kuhn F, Maisiak R, Mann L, Morris R, Witherspoon C, Pieramici D. The Ocular Trauma Score (OTS): Prognosticating the final vision of the seriously injured eye. Ocul Trauma Princ Pract Thieme N Y 2002;12–4.

Schörkhuber MM, Wackernagel W, Riedl R, Schneider MR, Wedrich A. Ocular Trauma Scores in paediatric open globe injuries. Br J Ophthalmol 2014;98(5):664–8.

Shah MA, Shah SM, Applewar A, Patel C, Shah S, Patel U. Ocular Trauma Score: A Useful Predictor of Visual Outcome at Six Weeks in Patients with Traumatic Cataract. Ophthalmology 2012;119(7):1336–41.

Gervasio KA, Weinstock BM, Wu AY. Prognostic Value of Ocular Trauma Scores in Patients with Combined Open Globe Injuries and Facial Fractures. Am J Ophthalmol 2015;160(5):882–8.

Agrawal R, Wei HS, Teoh S. Prognostic factors for open globe injuries and correlation of Ocular Trauma Score at a tertiary referral eye care centre in Singapore. Indian J Ophthalmol 2013;61(9):502–6.

Turgut B, Kobat SG, Tanyildizi R. The Usage of Ocular Trauma Scoring in the Visual Prognostic Evaluation of Traumatic Eye Injury. Med Sci 2014;3(2):1224–33.

Sobacı G, Akin T, Erdem U, Uysal Y, Karagü S. Ocular Trauma Score in Deadly Weapon–related Open-globe Injuries. Am J Ophthalmol 2006;141(4):760–1.

Iqbal Z, Ishtiaq O, Ishaq M, Ahmad J, Mukhtar A, Saeed S. Ocular trauma score in open globe injuries inflicted on troops fighting on western front of Pakistan. Pak Armed Forces Med J 2013;63(3):429–32.

Moreno L, Velasquez LF, Restrepo CA, Paulo JD, Donado J, Muñoz ML, et al. Ocular trauma from land mines among soldiers treated at a University Hospital in Medellín, Colombia. Colomb Méd (Cali) 2013;44(4):218–23.

Smith M, Colyer M, Greenberg D. Correlation of ocular trauma score and visual acuity outcomes in combat-related traumatic cataracts. Invest Ophthalmol Vis Sci 2013;54(15):4436.

Yu Wai Man C, Steel D. Visual outcome after open globe injury: a comparison of two Prognostic models - The Ocular Trauma Score and the Classification and Regression Tree. Eye (Lond) 2010;24(1):84–9.

Meng Y, Yan H. Prognostic Factors for Open Globe Injuries and Correlation of Ocular Trauma Score in Tianjin, China. J Ophthalmol 2015;2015:345764.

Weichel ED, Colyer MH, Ludlow SE, Bower KS, Eiseman AS. Combat Ocular Trauma Visual Outcomes during Operations Iraqi and Enduring Freedom. Ophthalmology 2008;115(12):2235–45.

Vlasov A, Ryan DS, Ludlow S, Weichel ED, Colyer MH. Causes of combat ocular trauma-related blindness from Operation Iraqi Freedom and Enduring Freedom. J Trauma Acute Care Surg 2015;79(4 Suppl 2):S210–5.

Erdurman FC, Hurmeric V, Gokce G, Durukan AH, Sobaci G, Altinsoy HI. Ocular injuries from improvised explosive devices. Eye (Lond) 2011;25(11):1491–98.