Proposal of a new classification scheme for periocular injuries

ABSTRACT

Background: Eyelids are important structures and play a role in protecting the globe from trauma, brightness, in maintaining the integrity of tear films and moving the tears towards the lacrimal drainage system and contribute to aesthetic appearance of the face. Ophthalmic trauma is an important cause of morbidity among individuals and has also been responsible for additional cost of healthcare. Periocular trauma involving eyelids and adjacent structures has been found to have increased recently probably due to increased pace of life and increased dependence on machinery. A comprehensive classification of periocular trauma would help in stratifying these injuries as well as study outcomes. Material and Methods: This study was carried out at our institute from June 2015 to Dec 2015. We searched multiple English language databases for existing classification systems for periocular trauma. We designed a system of classification of periocular soft tissue injuries based on clinico-anatomical presentations. This classification was applied prospectively to patients presenting with periocular soft tissue injuries to our department. Results: A comprehensive classification scheme was designed consisting of five types of periocular injuries. A total of 38 eyelid injuries in 34 patients were evaluated in this study. According to the System for Peri-Ocular Trauma (SPOT) classification, Type V injuries were most common. SPOT Type II injuries were more common isolated injuries among all zones. Discussion: Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. The SPOT classification has taken into account the periocular soft tissue injuries i.e., upper eyelid, lower eyelid, medial and lateral canthus injuries., based on observed clinico-anatomical patterns of eyelid injuries. Conclusion: The SPOT classification seems to be a reliable system to address eyelid injuries. This classification scheme would guide the ophthalmic and facial reconstructive surgeons to provide optimal outcomes in eyelid injuries. Based on the classification scheme and review of existing literature, an algorithm is presented to facilitate repair and reconstruction.

KEY WORDS

Algorithm - eyelid injures - eyelid repair - eyelid trauma treatment - injury classification - ocular injuries - periocular trauma - System for peri-ocular trauma classification

• REFERENCES

• 1 Woo JH, Sundar G. Eye injuries in Singapore – Don't risk it. Do more. A prospective study. Ann Acad Med Singapore 2006; 35: 706-18
• 2 Kretlow JD, McKnight AJ, Izaddoost SA. Facial soft tissue trauma. Semin Plast Surg 2010; 24: 348-56
• 3 Spinelli HM, Jelks GW. Periocular reconstruction: A systematic approach. Plast Reconstr Surg 1993; 91: 1017-24
• 4 Sarabahi S, Kanchana K. Management of ocular and periocular burns. Indian J Burns 2014; 22: 22-32
• 5 Pargament JM, Armenia J, Nerad JA. Physical and chemical injuries to eyes and eyelids. Clin Dermatol 2015; 33: 234-7
• 6 Audigé L, Bhandari M, Hanson B, Kellam J. A concept for the validation of fracture classifications. J Orthop Trauma 2005; 19: 401-6
• 7 World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10^th Revision (ICD-10)-WHO Version for; 2016. Available from: http://www.apps.who.int/classifications/icd10/browse/2016/en#/S00.2 [Last accessed on 2016 Dec 12].
• 8 Manolidis S, Weeks BH, Kirby M, Scarlett M, Hollier L. Classification and surgical management of orbital fractures: Experience with 111 orbital reconstructions. J Craniofac Surg 2002; 13: 726-37
• 9 Subramanian N. Reconstructions of eyelid defects. Indian J Plast Surg 2011; 44: 5-13
• 10 White WL, Hollsten DA. Burns of the ocular adnexa. Curr Opin Ophthalmol 1994; 5: 74-7
• 11 Gilbert L, Pogorzalek N, Jounda G, Barreau E. Traumatic peri-ocular injuries: Closing wounds using 2-octyl-cyanoacrylate medical glue. J Fr Ophtalmol 2009; 32: 341-7
• 12 Tintle SM, Levin LS. The reconstructive microsurgery ladder in orthopaedics. Injury 2013; 44: 376-85
• 13 Friji MT, Mohapatra D, Kumar DS. The reconstructive microsurgery ladder in orthopedics. Injury 2014; 45: 1020
• 14 Sundar G. Lacrimal trauma and its management. In: Javed Ali M. editor. Principles and Practice of Lacrimal Surgery. 1st ed.. New Delhi: Springer India; 2015: 159-70