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BETTS
Birmingham Eye TraumaTerminology System (BETTS)
This comprehensive, standardized
system of eye trauma terms,should be
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utilized when reporting to USEIR.
Endorsed by: Mandated by:
• World Eye Injury Registry • Graefe’s Archives
• American Academy ofOphthalmology • Klinische
onats!l"tter
• International #ociety of Ocular
$rauma • Ophthalmology
• Retina #ociety
• %nited #tates Eye InjuryRegistry
• &itreous #ociety
• World Eye Injury Registry
• American #ociety of Ocular$rauma
http://isotonline.files.wordpress.com/2013/03/bettschart.png
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BETTSlossary of Terms
Term !efinition and e'planation
Eyewall
Sclera and cornea.
$hough technically the eye(all has three coats posterior to
the lim!us) for clinical
and practical purposes violation of only the
moste'ternal structure is ta*en into consideration
Closed globeinjury "o full# thic$ness wound of eyewall.
Open globeinjury %ull# thic$ness wound of the eyewall.
Contusion
There is no &full# thic$ness' wound.
$he injury is either due to direct energy delivery!y the o!ject
+e, g,) choroidal rupture- or tothe changes in the shape of
the glo!e +e, g,)
angle recession-
amellarla!eration (artial# thic$ness wound of the eyewall.
"upture
%ull# thic$ness wound of the eyewall, caused by a
bluntob)ect.
#ince the eye is filled (ith incompressi!le li.uid)the impact
results in momentary increase ofthe IO/, $he eye(all yields at
its (ea*est point+at the impact site or else(here0 e'ample1 an
oldcataract (ound dehisces even though the
impact occurred else(here-0 the actual (ound is produced
!y an inside2 out mechanism
a!eration
%ull# thic$ness wound of the eyewall, caused by a
sharpob)ect.
$he (ound occurs at the impact site !y anoutside2 in
mechanism
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#enetratinginjury
Entrance wound.
If more than one (ound is present) each
must have !een caused !y a different agent
Retained foreign ob)ect* s.
$echnically a penetrating injury) !utgrouped separately !ecause
of differentclinical implications
#er$oratinginjury
Entrance and e+it wounds.
3oth (ounds caused !y the same agent
%Some injuries remain di$$i!ult to !lassi$y& 'or instan!e an
intraitreal BB pellet iste!hni!ally an *O'B injury& +oweer
sin!e this is a blunt obje!t that re,uires a hugeimpa!t $or!e i$
they enter not just !ontuse the eye there is an element o$
ruptureinoled& *n su!h situations the ophthalmologist should
either des!ribe the injury as-mi.ed/ (i& e& rupture with an
*O'B) or sele!t the most serious type o$ theme!hanisms
inoled&
Discussion 0orldwide interest in o!ular trauma is rapidly
growing as in!reasingly e$$e!tiete!hni,ues $or preention and
treatment are deeloped& #ro$essional asso!iations
(*nternationalSo!iety o$ O!ular Trauma1nited States Eye *njury
"egistry) hae been $ormed to promote resear!h anddisseminate its
results&1n$ortunately the la!2 o$ an unambiguous !ommon
language remains a majorlimiting $a!tor in e$$e!tielysharing eye
injury in$ormation: arying responses are gien to simple ,uestions
su!has What is the distinction !et(een laceration) rupture)
penetration) and perforation4
Is a full2 thic*ness scleral (ound (ithout o!vious choroidal and
retinal involvementan open glo!e injury4 If a foreign !ody has
traversed the eye and lodged in the or!it)is it perforating4 dou!le
perforating4 dou!le penetrating4 )& 3espite these
ambiguities whether publishing in a peer4 reiew journal
ordis!ussing patient re$erral oer the telephone
ophthalmologists !ontinue to use !ertain o!ular trauma terms
ratherthan lengthy des!riptions to !hara!teri5e the eye6s
!ondition& Our !olleagues7de$inition and understanding o$ these
terms are assumedidenti!al to ours with ea!h term haing a
de$inition whi!h is unambiguous andindependent o$ su!h ariables as
time indiiduality geographi!al lo!ation and pla!eo$ training&
*t is also !ommonly assumed that a one4to4one relationship
between
!ondition and term e.ists: there is no !ondition whi!h !an
alternatiely be des!ribedby more than a single term and there is no
term !hara!teri5ing more than a single
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!lini!al !ondition& 1n$ortunately our reiew o$ s!ienti$i!
journals and re$eren!e boo2sproed these assumptions to be
in!orre!t&0ithout a standardi5ed terminology o$ eye injury
types it is impossible to designproje!ts li2e the 1nited
States Eye *njury "egistry (1SE*") or the 0orld Eye *njury
"egistry (0E*")8 !lini!altrials in the $ield o$ o!ular trauma
!annot be planned8 and the !ommuni!ationbetween ophthalmologists
remains ambiguous& 9standardi5ed terminology $or eye injury has
been deeloped based on e.tensiee.perien!e& *t has thenundergone
repeated reiews by international ophthalmi! audien!es
in!orporatingsuggestions $romrespondents in ; !ountries and
sele!ted o!ular trauma e.perts& By always using theentire globe
as the tissue o$ re$eren!e !lassi$i!ation is unambiguous !onsistent
andsimple& *t proides de$initions $or the !ommonly used eye
trauma terms within the$ramewor2 o$ a !omprehensie system&
ETTSBETTS satis$ies all !riteria by:) proiding a !lear
de$inition $or all injury types (Table )
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Sundaram atara-an, um*ai,(ndia
Daid %ela#es, uenos Aires,Argentina
/ol&gang Schrader,urem*erg, $erman#&hairman of
theBoard% Ro*ert orris,irmingham, AL, USA
A'liated societies%American Academ# o&0phthalmolog#
American Societ# o& 0cular 1rauma
Asia %aci2c 0phthalmic 1rauma Societ#
%an3American Societ# o&0cular 1rauma
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