道路交通事故眼损伤伤残评定的标准化和规范化

GB18667-2002《道路交通事故受伤人员伤残评定》标准（以下简称“标准”）中有关眼损伤的条款较为原则和笼统。随着“标准”的广泛应用,加之法医学和临床眼科学技术的不断进步,对眼损伤后遗症的检验技术和认识水平已有较大的提高。建议采用视力表投影仪代替国际视力表进行行为视力检查,存在屈光不正的应了解屈光度后再检查其矫正视力;疑有伪盲或伪装视力降低时,可行伪盲试验或伪装视力降低的检验,视觉电生理技术是测试伪盲或伪装视力降低的有效方法。运用电脑视野计可进行视野检查,动态视野检查结果可通过视野有效值换算为残存视野半径（或直径）;视野检查存在一定的干扰因素,分析时应密切结合原发损伤及其他检查结果。对于遗留复视等双眼视障碍的,可采用同视机等检查方法,检验结果应考察功能障碍与眼肌等原发性损伤的符合性。泪器损伤后遗留溢泪症状的,应采用相应的检查方法证实泪道狭窄或梗阻。眼睑下垂及眼睑畸形分为轻度及重度;眼睑畸形包括闭合不全、眼睑缺损及眼睑外翻等情形。影响视力的外伤性白内障符合“标准”相关条款的规定。根据现行“标准”对道路交通事故所致眼损伤进行伤残评定,应进行视觉功能检测、眼球结构检查、伪盲试验及视觉电生理检测,最后综合病史材料及既往情况综合分析,得出评定结果。统一对现行“标准”的理解,规范检测手段和结果评价原则,有助于道路交通事故眼损伤伤残评定的标准化和规范化。

Standard Assessment for Impairment of Eye Injuries in Traffic Accidents

Provisions regarding eye injuries in GB18667-2002 ＂Impairment Assessment for the Injured in Road Traffic Accidents＂（referred to as the ＂standard＂） are doctrinal and unspecific.With the broad application of the ＂standard＂,together with the advance of forensic science and ophthalmology,inspection techniques and understandings of the sequela of eye injuries have been greatly improved.The visual acuity chart projector is recommended to test visual acuity instead of the traditional vision chart.The refractive error is required to be rectified after diopter is acquired.Pseudo-blind or blurred vision need to be tested when they are in suspicion,Visual electrophysiological technique is an effective method.Automated perimetry can be applied to examine visual field,and the virtual value of kinetic visual field can be converted to radius（or diameter） of relic visual field.There are some interfering factors in the examination of visual field.Analysis should be closely integrated with primary injury and other inspection results.Binocular obstacles such as diplopia can be tested with synoptophore.Compliance between dysfunction and primary injury should be considered in the test result.When epiphora symptoms are left after lacrimal apparatus injury,the lacrimal duct stenosis or obstruction should be confirmed by appropriate inspection methods.Blepharoptosis and eyelid deformities are divided into mild and severe.Eyelid deformities include incomplete eyelid closure,eyelid defect and eyelid ectropion.Assessment of traumatic cataract affecting vision should be correlated with the relevant provisions.According to the existing ＂standards＂,assessment of impairment degree of eye injuries caused by road traffic accidents should perform visual function test,eye structural inspection,pseudo-blind test and visual electrophysiological test.Finally,the assessment should be made by a comprehensive analysis including materials of medical history and past cases.Unitive understanding of the current ＂standard＂ and standardizing of test methods and evaluation principles will contribute to the standardization of the assessment of disability for eye injuries in traffic accidents.