Novel concepts of management in ocular and orbital trauma: ophthalmic zones of care (ZOCs)

Abstract

Introduction
Trauma is a leading cause of ophthalmic pathology worldwide. Its management requires an organized, systematic treatment approach from the point of injury (POI) to definitive care and rehabilitation. Currently, no such systems exist. Standardized concepts and lexicon would aid the development of such systems. Staged provision of care across echelons of increasingly sophisticated medical facilities is a conceptual hallmark in the doctrine, organization, and theories practiced by the military on the battlefield. It creates an organized continuum for critical interventions from the POI and damage control facilities in the Pre-Hospital Zone of Care (Roles 1 and 2) through definitive specialty care in rearward areas (Roles 3, 4, and 5). But because only ophthalmologists can provide even Damage Control stabilization for eye injuries and are found only at select R3 and rearward facilities—thereby shifting care paradigms to the right—this conventional characterization of ZOCs does not hold for ocular trauma. A similar discrepancy exists in civilian trauma. A modified concept is needed.
Report/Methods/Results
Ophthalmic ZOCs can be divided broadly into Pre-Ophthalmic and Ophthalmic ZOCs (pOZOC, OZOC). The pOZOC includes traditional R1 and 2 Pre-Hospital as well as larger non-ophthalmic R3 trauma facilities. Care in this ZOC is defined primarily by mitigation efforts by non- ophthalmologists to prevent visual demise. OZOC is defined as the first point at which an ophthalmologist is available to intervene, through subsequent postoperative and definitive care and rehabilitation. This conceptual spectrum may be applied to any environment or crisis situation including urban, rural or mass casualty events.
Conclusions
The proposed characterization of Ophthalmic ZOCs as standardized lexicon will help crystalize essential concepts in the management of ocular trauma. This will be important in medical education and in creating appropriate treatment algorithms and practice patterns as ocular trauma systems are developed.