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Ocular Trauma: Principles and Practice

Katz, Steven E.

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Optometry and Vision Science: March 2003 - Volume 80 - Issue 3 - p 196
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Ocular Trauma: Principles and Practice Ferenc Kuhn and Dante J. Piermici New York: Thieme, 2002. Pages: 496. Price: $149.00. ISBN 1-58890-075-4.

This is a long overdue book extolling advances made in the area of ocular trauma, which has emerged as a distinct discipline during the past decade. The majority of patient visits to the eye care specialist are scheduled in the outpatient setting. In contradistinction, the ocular trauma patient presents emergently to the office or through the emergency room and must be examined in less than ideal circumstances. History taking, physical examination, and the initial course of action must occur rapidly to reduce the risk of morbidity and even mortality. In the introduction to this book, the editors’ stated goal is to provide readers with current information on the management of eye injuries with an emphasis on “clinically relevant” material. They favored structured lists and summary tables over lengthy paragraphs in an effort to make the information easily accessible to the reader. Take home messages are presented as “Pearls,” “Pitfalls,” and “Special Considerations” in highlighted boxes. Controversial and unsettled issues are addressed openly with relatively objective assessment of diametrically opposed viewpoints. In a unique preamble to the book (Serious Eye Injury: The Patient’s Perspective), two patients describe their personal experiences with severe eye trauma.

Section I, Special Considerations, includes chapters on the terminology, Birmingham Eye Trauma Terminology (BETT), and the classification of ocular trauma. Older literature has been confusing and incomparable due to a lack of uniform terminology. In chapter 3, the Ocular Trauma Score (OTS) is described as a rapid digital method to predict the outcome of a serious eye injury. Chapter 4 is dedicated to eye injury epidemiology with emphasis on the United States Eye Injury Registry (USEIR) and preventive measures. I applaud the inclusion of Chapters 5 through 7, which cover topics that are generally not given enough consideration: Counseling the Patient and the Family, Rehabilitation of Patients with Ocular Trauma, and Medicolegal Issues. Chapters 8 and 9 provide an overview on patient evaluation and designing a management strategy. Section II, Emergency Management, highlights the fact that management begins with the initial triage phone call and may include advice on how to manage the patient before and during transport.

Section III, Mechanical Globe Injuries, reviews injuries on a “tissue-by-tissue basis.” Additional chapters are dedicated to specific topics including intraocular foreign bodies, endophthalmitis, sympathetic ophthalmia, and childhood ophthalmic injuries. Section IV addresses nonmechanical globe injuries, and Section V addresses trauma to the ocular adnexa, orbit, visual pathways, and sensorimotor system. The evolution of current thinking about traumatic optic neuropathy is particularly well summarized. The chapter on orbital trauma provides a nice overview of orbital blowout fractures, orbital foreign bodies, and orbital volume augmentation. Issues including frontal sinus fractures, tripod fractures, Lefort fractures, and basilar skull fractures are not adequately addressed. Combined ocular, orbital, and para-orbital injuries are common and should be evaluated and managed in cooperative multi-disciplinary fashion. Lastly, Section VI offers a series of useful appendices including instrumentation, basic surgical techniques, and pharmacology.

Overall, this text is well illustrated and the reference lists are excellent. The editors and authors are comprised of the predominant experts leading the information gathering and new focus on evidence-based care. I strongly recommend this book to anyone who will take part in the care of this challenging group of patients.


© 2003 American Academy of Optometry