Diagnostic Index for Diseases of the Eye
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1 Brit. J. Ophthal. (1970) 54, 348 Diagnostic Index for Diseases of the Eye Based on the International Statistical Classification of Diseases (ICD) J. F. CULLEN Department of Ophthalmology, Royal Infirmary and University of Edinburgh. The necessity for an adequate diagnostic index in an eye department, both for in-patients and for those attending the out-patient department, is universally recognized, and a number of different systems are in use throughout the United Kingdom. In the busy atmosphere of an out-patient clinic it is essential that the diagnostic number or code be readily available to the medical personnel so that they can enter the diagnosis and the code number on the patients' case notes at the time of examination. Alternatively, if the doctor does not do the coding, it must be easy for the secretary or clerk to find the number quickly and efficiently so that it can be entered when the letter or report about the patient is typed before the case notes are returned to file. In designing any diagnostic index nowadays, it is necessary to plan one which will be suitable for data processing and computer analysis in the future, and also one which may be generally accepted throughout the country for national surveys and other research projects. In some places the classification of diseases from Ophthalmic Literature is in use, but this is only suitable for small eye departments (Blach, I967). Another system based on the "Standard Nomenclature of Diseases and Operations" (I96I) published for the American Medical Association has been used in a number of departments, including until recently Edinburgh. The Moorfields Eye Hospital "Code for Diagnoses and Operations", which has both topographical and aetiological sections, as well as a code of operations, is suitable for large eye hospitals and is now in use in a number of centres. In addition, many eye departments and hospitals have their own private systems. In Great Britain the classification of diseases adopted for general use in all hospitals and accepted by the Ministry of Health in England and Wales and the Scottish Home and Health Department in Scotland, is based on the International Classification of Diseases (ICD)" approved by the World Health Organization. The Eighth Revision (I967) of the ICD is now incorporated into two volumes entitled "Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death"; volume one contains mainly the tabular list of inclusions, and volume two an alphabetical index of diseases and nature of injuries. This classification, which is basically a three-digit system with some Received for publication November 7, 1969 Address for reprints: Department of Ophthalmology, The Royal Infirmary, Chalmers Street, Edinburgh EH3 gha.
2 Diagnostic Index for Diseases of the Eye four-digit subcategories, is used throughout the country for in-patient hospital returns and has been given trials for out-patient use. The ICD code contains a small and rather inadequate section for diseases of the eye in the division on the nervous system and sense organs. Only twenty numbers, , have been allotted to eye conditions, but all medical disorders which may have eye manifestations or complications have in addition their own diagnostic number in other parts of the code outside the Eye section; for example Sarcoidosis is I35 and Diabetes Mellitus is 250, but Diabetic Retinopathy is not mentioned under diseases of the eye. The ICD classification having been found inadequate in its present form for use in large eye departments, the International Council of Ophthalmology has recommended yet another system entitled "Coding System for Disorders of the Eye" (suggested abbreviation CDE). This index, based on an original system devised by Dr. S. Franken of Utrecht and now modified by Drs. Schappert-Kimmijser and Colenbrander, was finally published in I968 in English after approval by the International Council of Ophthalmology and the International Federation of Ophthalmological Societies who recommend its use for ophthalmological purposes in member countries (Kimmijser, Colenbrander, and Franken, I968). The CDE is a six-digit system containing between five and six thousand separate items. It is laid out in alphabetical order over I 63 pages covering every possible eye condition and syndrome. Although this would be suitable for use in big departments having abundant secretarial assistance, it is not a practical proposition for everyday use in a busy eye department in Great Britain. In Edinburgh, therefore, we have now examined again the ICD code with its two sections "Inflammatory Diseases of the Eye" (36o-369) and "Other Diseases and Conditions of the Eye" ( ) under the general heading (VI) "Diseases of the Nervous System and Sense Organs". In order to fit into it all the eye conditions we encounter we have altered the aetiological headings to topographical headings (i.e. 360 Conjunctivitis becomes ) and have used the fourth digit in each of the twenty categories available, so giving a possible two hundred different diagnostic items. In order to include all the parts of the eye and adnexa, it was necessary to change the designation of three of the official numbers as follows:- 362 from 'hordeolum' to 'orbit' 37I from 'corneal opacity' to 'miscellaneous visual disturbance' 378 from 'other diseases of the eye' to 'visual pathway'. This modified ICD system has been in use in Edinburgh for the past year and has also been tried out in a number of other centres in Great Britain. A final revision has now been made in the light of comments from users, and omissions from the original draft which have been discovered have now been included in the final code. Because of the interest shown in this system by a number of eye units throughout the country, it was decided to seek publication in the British 30urnal of Ophthalmology so that those interested would find it readily available to them. It would also be advantageous if the authorities could be persuaded to accept the suggested alteration to the Eye Section because, at the present time, the I967 edition of the Manual incorporating the ICD system is in use for in-patient returns to the Ministry of Health and the Scottish Home and Health Department, so that this modified system can, at the moment, be used only for local diagnostic coding in the eye departments themselves and not on official returns. 349
3 F. Cullen Before tabulating the diagnostic index in full, the following ideas incorporated in the modified code are worth pointing out: (I) The o and *I subcategories of each of the twenty numbers are given to the commonest conditions under each heading, e.g. cataract is 374-0, concomitant divergent squint is (2) Some conditions have been cross-referenced under different topographical sections e.g. phakolytic glaucoma (374 4) is included under both the lens section and the glaucoma section. This is to allow for quick and easy finding of the condition by different diagnosticians. (3) Certain common eponyms or syndromes are listed because medical staff may use different terms to describe the same condition, and all such terms should be available to a lay person who may be doing the coding. (4) Eye conditions which have their own number outside the range, i.e. viral diseases of the conjunctiva; neoplasms; trauma, etc., have been included in the tabulated lists under the appropriate part of the eye, and a list of the commonest medical conditions with ocular manifestations is given separately in Appendix I. (5) With regard to trauma, the extra digit (.o to g) is given to the same part of the eye throughout, as listed in Appendix II. This extra digit is shown in parenthesis after each heading of the main list. For neoplasms, however, as also seen in Appendix II, the assignment of the extra digits is a little different in order to include neoplastic lesions of the extraocular structures. (6) In all categories an indefinite heading is included under -9. I am greatly indebted to our departmental secretaries Mrs. Anne Roger and Mrs. Susan Hauge for their assistance in compiling the diagnostic index and in the preparation of this paper. References BLACH, R. K., (i967) Trans. ophthal. Soc. U.K., 87, 6I7 KIMMIJSER, J. s., COLENBRANDER, A., and FRANKEN, s. (i968) "Coding System for Disorders of the Eye". Karger, Basel WORLD HEALTH ORGANISATION (I967) "Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death", 8th revision, 2 volumes. W.H.O., Geneva. AMERICAN MEDICAL ASSOCIATION (I96I) "Standard Nomenclature ofdiseases and Operations", 5th ed., ed. E. T. Thompson and A. C. Hayden. McGraw-Hill, New York. Br J Ophthalmol: first published as /bjo on 1 May Downloaded from on 13 June 2018 by guest. Protected by copyright.
4 Diagnostic 'Index for Diseases of the Eye Classification 360 CONJUNCTIVA (.O) 360.o Acute, non-viral conjunctivitis Allergic conjunctivitis (including spring catarrh) Chronic conjunctivitis Late effects of conjunctivitis (concretions; granuloma, etc.) Degenerations of conjunctiva (pingueculae, etc.) Phlyctenular conjunctivitis and keratoconjunctivitis Spontaneous subconjunctival haemorrhage Symblepharon l cysts Other and unspecified diseases of conjunctiva 053.o Herpes zoster conjunctivitis 054.o Herpes simplex conjunctivitis 076 Trachoma 077 Late effects of trachoma 078. I Epidemic keratoconjunctivitis Adenoviral keratoconjunctivitis Viral conjunctivitis (unspecified) Gonococcal conjunctivitis and ophthalmia neonatorum I90.0 Malignant neoplasm of conjunctiva Benign neoplasm of conjunctiva N870.o Open wound of conjunctiva Contusion wound of conjunctiva N N930.o N940.o N96o (haemorrhage, etc.) l foreign body Burn of conjunctiva Adverse effect of chemical agents (specify) 36I LIDS (. I) 36 I.O Blepharitis (squamous; ulcerative) 36I.I Allergic conditions (oedema, etc.) 36i.2 Abscess of lid 36i.3 Ectropion 36I.4 Entropion Stye, hordeolum 36 i.6 Chalazion; Meibomian, tarsal cyst, etc. 36I.7 Ptosis 36I.8 Trichiasis 36i.9 Other and unspecified diseases of the lid 053. I 054. I Herpes zoster ophthalmicus involving lids Herpes simplex of lids Molluscum contagiosum I72.1 Malignant melanoma, lids, and canthi I 73.1 Other malignant neoplasms of lids 2i6.3 Benign neoplasm of skin of lid (papilloma, angioma etc.) Xanthoma (xanthelasma and all diseases of lipid metabolism) Sebaceous cyst of lid Congenital anomalies of lids (excluding epicanthus ) 757. I Benign naevus of skin of lid N870.I Open wound of lids N92I. I Contusion wound of lids (black eye) N930.I Subtarsal foreign body N940.I Burn of lids N96o Adverse effect of chemical agents (specify) I i N802.4 ORBIT Orbital cellulitis Endocrine exophthalmos (thyrotoxic, non-infiltrative) Endocrine exophthalmos (thyrotrophic, infiltrative) Exophthalmos, proptosis (not caused by tumour) Reticuloses involving orbit Pseudotumour of orbit Mucocele invading orbit Foreign body retained in orbit Orbital decompression Other and unspecified diseases of orbit Malignant neoplasm of orbit Benign neoplasm of orbit Fracture (blowout, etc.) of orbit 363 CORNEA (.2) Infective, non-viral corneal ulcer and hypopyon l scarring from ulcers etc Exposure keratitis; neuroparalytic keratitis Degenerative conditions (band keratitis; descemetocele) Marginal and catarrhal keratitis l graft Stiperficial punctate keratitis Disciform keratitis l dystrophy (keratoconus, etc.) of cornea Herpes zoster keratitis Herpes simplex keratitis (dendritic, etc.) Interstitial keratitis I90.2 Malignant neoplasm of cornea I Benign neoplasm of cornea Xerophthalmia and keratomalacia Rosacea keratitis Kerato-conjunctivitis sicca (Sj6gren's) Congenital conditions of cornea (megalocornea; dermoids, etc.) N870.2 Open wound of cornea N92 I.Z Contusion wound of cornea (abrasion, etc.) N930.2, l foreign body N940.2 Burn of cornea 35x-
5 Qr% I N870.3 N921.3 N930-3 IRIS AND CILIARY BODY (.3) Iritis and iridocyclitis Heterochromic cyclitis Lens-induced uveitis End result of anterior uveitis (synechiae, etc.) Sympathetic uveitis Pupillary abnormalities (Adie; Homer's; Argyll Robertson pupil, etc.) Mydriasis (including traumatic) Miosis (including congenital) Cysts of iris and ciliary body of iris and ciliary body Malignant neoplasm of iris and ciliary body Benign neoplasm of iris and ciliary body Coloboma of iris and ciliary body Aniridia Open wound of iris and ciliary body Contusion wound of iris and ciliary body (hyphaema) Foreign body in iris or ciliary body 365 CHOROID (.4) Choroiditis (active) Choroiditis (healed) Disseminated choroiditis Degenerations (sclerosis, etc.) Drusen, colloid bodies Detachment of choroid Choroidal haemorrhage Choroideremia Choroidal naevus of choroid Malignant neoplasm (primary and secondary) of choroid Benign neoplasm of choroid Coloboma of choroid N870.4 Penetrating wound involving choroid N92 I.4 Contusion wound of choroid (tears, etc.) N930.4 Foreign body in choroid o 366. I N870-5 N N930.5 VITREOUS (.5) Vitreous floaters Vitreous detachment Vitreous haemorrhage Retinitis proliferans (fibrous tissue in the vitreous) Recurrent vitreous haemorrhage (Eales's disease) Asteroid bodies and synchisis scintillans Vitreous infection (endophthalmitis) Persistent hyperplastic primary vitreous Retrolental fibroplasia of vitreous Open wound involving vitreous (loss, etc.) Contusion injury including haemorrhage Foreign body retained in vitreous I F. Cullen OPTIC NERVE (.6) Optic neuritis and retrobulbar neuritis Neuromyelitis optica Optic atrophy Ischaemic optic neuropathy Papilloedema (plerocephalic) Pseudopapilloedema Papilloedema (not plerocephalic) Toxic amblyopias; optic neuropathy (tobacco amblyopia, etc.) Physiological cupping of disc (see 375) of optic nerve i90.6 Malignant neoplasm of optic nerve Benign neoplasm of optic nerve Congenital anomalies of optic nerve (opaque nerve fibres, etc.) N870.6 N930.6 N950.o o 368.I o N870.7 N N930.7 N Penetrating injuries involving optic nerve Foreign body in optic nerve Injury of optic nerve LACRIMAL SYSTEM Infantile dacryocystitis, congenital obstruction, etc. Acute dacryocystitis Chronic dacryocystitis and nasolacrimal obstruction Other obstructions, ampullary, etc. Epiphora-no obvious cause Dacryoadenitis, infective Dacryoadenitis, associated with other disease (mumps, etc.) Diminished secretion (excluding Sjogren's, 734-9) Malignant neoplasm of lacrimal gland Benign neoplasm of lacrimal gland SCLERA (.7) Episcleritis Scleritis Sclerokeratitis Sclero-malacia perforans Staphyloma (ciliary, etc.) of sclera Penetrating injury of sclera Contusion of sclera Foreign body in sclera Bum of sclera REFRACTIVE CONDrITONS Emmetropia Hypermetropia Myopia High myopia (over -6 D sph.) Astigmatism Anisometropia
6 Diagnostic Index for Diseases of the Eye ' 37I I I.4 37I I o 78I.2 79' I.I Refractive conditions (continued) Irregular astigmatism due to conical cornea, scarring, etc. Presbyopia Accommodation disorders MISCELLANEOUS VISUAL DISTURBANCES Amblyopia ex anopsia Amaurosis fugax Visual symptoms associated with migraine Angiospasm (retinal, etc.) Ocular and retro-ocular pain (unknown origin) Monocular diplopia Functional and hysterical syndromes Malingering and "compensationitis" Colour vision defects Night blindness Hemianopia and other field defects Photophobia Headaches PTERYGIUM Pterygium Pseudopterygium OCULAR MOTILITY Concomitant convergent squint Concomitant divergent squint Convergence insufficiency Pseudosquints (including epicanthus) and observation for squint Duane's and other retraction syndromes Paralytic squint A and V syndromes Vertical squint Phorias (including diplopia of indeterminate cause and supranuclear lesions) Miner's nystagmus Muscular dystrophies and myopathies Myasthenia gravis Nystagmus (including latent) LENS (.8) Senile cataract; lens opacities Pre-senile cataract Cataract secondary to other ocular disease Metabolic/endocrine cataract Hypermature cataract and complications (phakolytic glaucoma, etc.) Dislocation of lens (non-traumatic; Marfan's syndrome, etc.) Traumatic dislocation of lens Aphakia N870.8 N92 i.8 N930.8 Exfoliation of lens capsule of lens Congenital cataract (including rubella cataract) Penetrating injury to lens Contusion injury to lens Foreign body in lens (retained in eye) 375 GLAUCOMA 375.o Acute congestive (angle-closure and narrow-angle glaucoma) Simple glaucoma Secondary glaucoma (post-inflammatory) Post-traumatic glaucoma Absolute glaucoma Thrombotic glaucoma Steroid-induced glaucoma Aphakic glaucoma Observation for glaucoma Other and unspecified glaucomas Physiological cupping of optic disc (see 367) Phakolytic glaucoma (see 374) Congenital glaucoma (buphthalmos) o 376. I I N870.6 N92 i.6 N RETINA (Detachment, etc.) (.6) Detachment of retina (myopic, etc.) Detachment of retina (traumatic) Retinal cysts Retinoschisis Central serous retinopathy Coats's disease (exudative retinopathy) Macular oedema, holes, cysts, etc. Macular dystrophies (heredo-macular degeneration, etc.) Retinitis pigmentosa and other abiotrophies Other and unspecified non-vascular conditions of retina Malignant neoplasm (retinoblastoma) Benign neoplasm (hamartomas; phakomatoses, etc.) Colloid bodies (see 365) Retrolental fibroplasia (see 366) Coloboma Penetrating injury involving retina Contusion injury, commotio, etc. Foreign body retained in retina RETINA (Vascular disease, etc.) Diabetic retinopathy Macular degeneration (senile, haemorrhagic, disciform, etc.) Myopic macular degeneration Arteriosclerotic retinopathy Hypertensive retinopathy Retinopathy associated with blood dyscrasias Retinal vein thrombosis (central and branch) 353
7 Retina etc. (continued) Retinal arterial occlusions (central and branch) Retinal vasculitis Other and unspecified vascular diseases of retina Eales's disease (see 366) Temporal arteritis 378 VISUAL PATHWAY 378.o Optic nerve compression syndromes (intracranial not orbital) 378.x Chiasmal compression syndromes from tumours, aneurysms, etc Lesions of optic tracts (non-vascular) Lesions of optic radiations (non-vascular) Lesions of visual cortex (non-vascular) Vascular lesions affecting intracranial optic nerve Vascular lesions affecting chiasma, tracts, and geniculate bodies Vascular lesions affecting optic radiations and cortex Visual field defects associated with head injury Craniopharyngioma and other benign neoplasms of pituitary Pituitary eosinophil adenoma (acromegaly) Pituitary chromophobe adenoma BLINDNESS Blindness both eyes, specifically defined (VA: 6/60; field: 200 and less) Blindness both eyes, not specifically defined (inability to work) Blindness one eye, specifically defined Blindness one eye, not specifically defined Registered blind Registered partially sighted Blind child Enucleated eye (not trauma) Both eyes enucleated (not trauma) Other and unspecified causes CONGENITAL ANOMALIES Anophthalmos Microphthalmos Buphthalmos Cataract Coloboma Aniridia Congenital conditions of cornea (megalocomea, dermoids, etc.) Congenital anomalies of optic nerve (opaque nerve fibres, etc.) Congenital anomalies of lids (excluding epicanthus-373.4) Albinism TRAUMA, TOXIC EFFECTS OF DRUGS, ETC. J. F. Cullen N8oo Fracture of vault of skull N8oI Fracture of base of skull N802 Fracture of face bones N85o Concussion N854 Unspecified head injury N870 Open wound of eye and orbit (see part of eye) N87I Enucleation following injury N9Io Surface injury to face N920 Contusion of face, scalp, and neck (except eyes) N92 I Contusion of eye and orbit (see part of eye) N930 Foreign body (see part of eye concerned) N940 Burn of eye (see part of eye concerned) N96o-N979 Adverse effects of medicinal agents (specify) e.g. chloroquine, N96I.3 Promazine, N967.9 NO OCULAR ABNORMALITY Yo2.9 Eye investigations nothing abnormal discovered Br J Ophthalmol: first published as /bjo on 1 May Downloaded from Appendix I MEDICAL CONDITIONS Pulmonary tuberculosis 01I os6 Rubella ogo Congenital syphilis I 30 Toxoplasmosis 135 Sarcoidosis I47 Malignant neoplasm nasopharynx i62 Malignant neoplasm lung 174 Malignant neoplasm breast 191 Malignant neoplasm brain 192 Malignant neoplasm central nervous system (other parts) 208 Polycythaemia vera 2I6 Benign neoplasm of skin Benign neoplasm of brain Haemangioma and lymphangioma Thyrotoxicosis Diabetes mellitus Diseases of pituitary gland Diseases of adrenal glands Disorders of lipid metabolism Metabolic disorders (other) Anaemia (iron deficiency) Pernicious anaemia Purpuras Secondary polycythaemia Mental disorders Muscular dystrophies on 13 June 2018 by guest. Protected by copyright.
8 Diagnostic Index for Diseases of the Eye Medical Conditions (continued) I I I 432 Appendix II NEOPLASMS I90 Multiple sclerosis Migraine Facial paralysis Trigeminal neuralgia Rheumatic disease Malignant hypertension Essential benign hypertension Hypertensive renal disease Acute myocardial infarction Subarachnoid haemorrhage Cerebral haemorrhage Carotid disease MALIGNANT NEOPLASM OF EYE I 90.0 I 90. ILid I Iris and ciliary body Choroid Retina i9o.6 Optic nerve Lacrimal gland I 90.8 Orbit I 90.9 Unspecified TRAUMA N870 N870.0 N870.I N870.2 N870.3 N870.4 N870.5 N870.6 N870.7 N870.8 N870.9 N871 N9Io Ng2o N92I N921.0 N921.1 N92 I.2 N921.3 N OPEN WOUND OF EYE AND ORBIT Lid Iris and ciliary body Choroid Vitreous Retina/optic nerve Sclera Lens Unspecified ENUCLEATION (traumatic) SUPERFICIAL INJURY to face, scalp, and neck CONTUSION INJURY of face, scalp, and neck CONTUSION INJURY OF EYE AND ORBIT Lids Iris and ciliary body Choroid o I N92I.5 N92I.6 N92I.7 N92I.8 N92I.9 N950 N93o N930.0 N930. I N930.2 N93o.3 N930-4 N93o.5 N930.6 N930.7 N930.8 N N940 N940.0 N940.I N940.2 N94o.7 N940.9 Cerebral thrombosis Cerebral embolism Basilar-vertebral disease Cerebral aneurysm Arteriosclerosis Polyarteritis nodosa Temporal arteritis Acute sinusitis Chronic sinusitis Acute nephritis Chronic nephritis Rheumatoid arthritis Myasthenia gravis Congenital hydrocephalus BENIGN NEOPLASM OF EYE Lid Iris and ciliary body Choroid Retina Optic nerve Lacrimal gland Orbit Unspecified Vitreous Retina Sclera Lens Other and unspecified Injury of optic nerve FOREIGN BODY IN EYE AND ADNEXA Lid Iris and ciliary body Choroid Vitreous Retina/optic nerve Sclera Lens Unspecified Foreign body in orbit BURNS CONFINED TO EYE Lid Sclera Other and unspecified 355
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