Clinical Characteristics and Prognostic Factors Associated with Poor Ocular Trauma Score Categories: A Tertiary Referral Center Experience from Türkiye

Abstract

Background Ocular trauma is a leading cause of preventable visual impairment worldwide. Although the Ocular Trauma Score (OTS) and Pediatric Ocular Trauma Score (POTS) are widely used for prognostic assessment, studies evaluating factors associated with poor OTS/POTS categories across the full spectrum of ocular trauma remain limited. Therefore, this study aimed to characterize the full spectrum of ocular trauma in a tertiary referral center by evaluating demographic characteristics, injury patterns, clinical findings, and predictors of poor OTS/POTS categories in both adult and pediatric patients. Methods This retrospective cohort study included 500 consecutive patients presenting with ocular trauma between January 2023 and December 2025. Demographic characteristics, injury causes and mechanisms, injury-causing agents, ocular findings, treatment modalities, and OTS/POTS categories were recorded. Adult patients were assessed using the OTS, whereas pediatric patients were assessed using the POTS. Poor ocular trauma severity was defined as OTS/POTS categories 1–2. Univariable analyses and multivariable logistic regression were performed to identify independent predictors of poor OTS/POTS categories. Results A total of 500 patients (72.0% male; mean age, 32.35 ± 20.14 years) were included. OTS was applied to 403 (80.6%) adults and POTS to 97 (19.4%) pediatric patients. Accidents (35.4%) and assaults (24.2%) were the leading causes of injury, while blunt trauma was the predominant mechanism (68.6%). In univariable analyses, retinal detachment (OR, 115.2; 95% CI, 45.4–292.6), open-globe injury (OR, 68.6; 95% CI, 30.5–154.2), vitreous hemorrhage (OR, 58.8; 95% CI, 26.6–129.9), traumatic cataract (OR, 53.1; 95% CI, 24.3–116.4), hyphema (OR, 24.6; 95% CI, 12.1–50.0), and endophthalmitis (OR, 21.5; 95% CI, 3.8–121.0) were significantly associated with poor OTS/POTS categories (all p ≤ 0.001). In multivariable analysis, retinal detachment (OR 15.29, 95% CI 3.15–74.09; p = 0.001) and open-globe injury (OR 10.36, 95% CI 2.44–43.90; p = 0.002) remained independent predictors of poor OTS/POTS categories. Overall, nine patients (1.8%) underwent evisceration or enucleation. Conclusions This study provides a comprehensive overview of ocular trauma in a large cohort of adult and pediatric patients. Retinal detachment and open-globe injury were identified as independent predictors of poor OTS/POTS categories. Early recognition of these high-risk features may facilitate risk stratification, optimize clinical decision-making, and improve patient counseling.