Clinical Characteristics and Prognostic Factors Associated with Poor Ocular Trauma Score Categories: A Tertiary Referral Center Experience from Türkiye
This retrospective study of 500 patients at a Turkish tertiary referral center characterizes the spectrum of ocular trauma and identifies retinal detachment and open-globe injury as independent predictors of poor Ocular Trauma Score (OTS) and Pediatric Ocular Trauma Score (POTS) categories.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every year, millions of people around the world suffer injuries to their eyes. These incidents range from a simple scratch on the surface to devastating damage that can permanently ruin vision or even cost a person their eye entirely. Because the eye is so delicate and complex, doctors need a reliable way to look at an injury and immediately understand how bad it might be. To help with this, medical professionals use scoring systems. One system, designed for adults, assigns points based on what the doctor sees when the patient first arrives, such as how well they can see and what parts of the eye are damaged. A separate, similar system exists for children, because young patients often cannot describe their vision or cooperate with standard tests in the same way adults do. These scores help doctors predict the final outcome, decide on the best treatment, and speak honestly with families about what to expect. However, while these tools are widely used, there is still much to learn about exactly which specific injuries make the difference between a good recovery and a poor one, especially when looking at a wide mix of patients from different ages and backgrounds.
A team of researchers at Ankara Etlik City Hospital in Turkey set out to fill this gap by studying a large group of patients who arrived at their emergency eye department with trauma. They looked back at the records of 500 consecutive patients treated between January 2023 and December 2025. This group included both adults and children, covering the full spectrum of eye injuries, from minor bruises to severe internal damage. The researchers carefully recorded who the patients were, what caused the injury, how the injury happened, and exactly what they found inside the eye. They then applied the appropriate scoring system to each patient to categorize the severity of the trauma. Their goal was to find out which specific factors were most strongly linked to the worst possible scores, indicating a high risk of poor visual outcomes.
The study revealed a clear picture of how eye injuries happen in this region. The most common cause of injury was an accident, followed closely by physical assaults. When it came to the way the injury occurred, blunt force—being hit by something without breaking the skin of the eye—was the dominant mechanism, accounting for nearly seven out of ten cases. The objects involved varied widely, with human bodies and unspecified objects being the most frequently cited causes. The researchers also noted that men were significantly more likely to suffer these injuries than women, and they were also more likely to experience the most severe types of damage. Interestingly, while children in the study did show a slightly higher rate of severe injuries compared to adults, this difference was not statistically significant, suggesting that the risk factors might be more about the nature of the event than the age of the victim.
When the team analyzed the medical findings to see what predicted a poor outcome, two specific conditions stood out as the most powerful warning signs. The first was a retinal detachment, a serious condition where the light-sensitive layer at the back of the eye pulls away from its normal position. The second was an open-globe injury, which means the outer wall of the eye has been punctured or cut, exposing the internal structures. Patients who arrived with either of these conditions were vastly more likely to end up with a low score, indicating a grim prognosis for their vision. While other issues like bleeding inside the eye, clouding of the lens, or infection were also linked to worse outcomes in initial checks, only the retinal detachment and the open-globe injury remained as independent predictors when all the data was weighed together. This suggests that these two specific injuries are the most critical indicators of severe damage, regardless of other factors.
The study also looked at the most extreme cases, where the eye was so damaged that it had to be removed. Nine patients in the group underwent procedures to remove the eye. Almost all of these patients (88.9%) had received the lowest possible trauma scores. Furthermore, a very high proportion of these patients had suffered from an open-globe injury (77.8%) and a retinal detachment (66.7%). This tight connection confirms that when these severe injuries occur, the likelihood of saving the eye is extremely low. The researchers concluded that by recognizing these high-risk features right when a patient walks into the emergency room, doctors can better sort patients by risk, make more informed decisions about surgery, and provide families with clearer, more accurate information about the future of their vision. This work helps refine our understanding of eye trauma, moving beyond general statistics to identify the specific, tangible signs that tell us when an injury is truly catastrophic.
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