Novel concepts of surgical management in ocular and orbital trauma: damage control ophthalmology (DCO)

Abstract

Introduction
Trauma is a leading cause of ophthalmic pathology worldwide. Its initial surgical management remains a source of intimidation for both the non-ophthalmologist and ophthalmologist alike, largely because of a lack of a systematic conceptual approach to its management and a desire to provide comprehensive definitive care at first intention. By contrast, the larger trauma community has embraced the concept of damage control surgery which focuses initial surgical interventions on life saving procedures, intentionally deferring definitive repairs for later. Emphasis on staged interventions addressing the most pressing injuries that may lead to patient mortality and rendering only the most critical treatments that address the lethal triad of trauma are the hallmarks of these lifesaving strategies. Although an analogous strategy could aid ophthalmology, the concept of damage control ophthalmology (DCO) is nascent and not widely acknowledged, even within ophthalmic circles (particularly outside of the military). We suggest that DCO would provide an appropriate conceptual framework for addressing ocular trauma education and practice.
Report/Methods/ Results
DCO focuses on immediate eye saving measures, intentionally deferring definitive procedures for later. Its philosophies, principles, goals, and techniques address imminent ocular demise. It focuses on restoring ocular integrity, maintaining critical structures, and preventing infection while being aware of the intervention principles of necessity, urgency, adequacy and avoidance. Reflective of its exigent nature, DCO must be reevaluated and applied at every stage of care from the point of injury through definitive care.
Conclusions
The adoption, elaboration, and incorporation of DCO and DCO concepts into the lexicon of ophthalmic traumatology will help identify essential treatment steps in the management of ocular trauma and help develop trauma contingency considerations. These concepts could provide scaffolds by which treatment algorithms and practice patterns are created for eye-saving interventions, resulting in improvement of patient outcomes.