Request for expert feedback please – proposed revision of periocular structure hierarchy

Clinical Reference Groups Eye Care CRG
1

Dear CRG colleagues,

We have been doing some work in response to customer requests related to periocular conditions, as there is currently some inconsistent modelling in this area. Below is our proposed approach for the anatomy in this area for your review and input please.

We would really appreciate your feedback on:

  • Whether the proposed hierarchy aligns with clinical and anatomical understanding

  • The accuracy and completeness of the draft definitions

  • Any refinements or clarifications you would recommend

Best wishes,

Elaine

Proposed update

We propose introducing a new concept:

1381356005 |Structure of periocular region of eye (body structure)|, plus entire/lateralised variants.

and inactivating:

181142009 |External structure of eye region (body structure)|, plus its entire/lateralised variants.

The updated top-level hierarchy (excluding entire/lateralised forms) would look as follows:

  • Eye region structure (body structure)

    • Structure of eye proper (body structure) (eyeball)

    • Structure of periocular region (body structure)

      • Structure of orbital region of eye (body structure)

        • Structure of orbit proper (body structure)

      • Structure of periorbital region of face (body structure)

      • Ocular adnexa structure (body structure)

Draft definitions

  • 1381356005 |Structure of periocular region of eye (body structure)| - The periocular region of the eye encompasses the orbital and periorbital regions, the ocular adnexae.

  • 714483002 |Structure of orbital region (body structure)| - The orbital region includes the eyelids, lacrimal ducts, soft and connective tissues within the orbit and the orbital wall structures including bone and fascia.

  • 363654007 |Structure of orbit proper (body structure)| - The orbit proper includes the soft and connective tissues within the orbit and the orbital wall structures including bone and fascia, but excluding the eyelids and soft tissue not within the orbit.

  • 1711002 |Structure of periorbital region of face (body structure)| - The periorbital region includes the circumorbital and palpebral muscles along with the skin and subcutaneous tissue of the eye region including the eyelid and eyebrow.

  • 44888004 |Ocular adnexa structure (body structure)| - The ocular adnexae comprise the eyebrows, eyelids, conjunctiva, fascial sheath and tendons of the eye and the lacrimal apparatus.

2

Hi Elaine,

This seems sensible at first sight, I do have to caveat that we should get an orbital surgeon to give their view, are there any in the CRG? I can try and reach out to some if not.

I do wonder whether it would be sensible for the Ocular adnexa to be a child of the Structure of the periorbital region of face. Otherwise, which one will be the parent for codes for the eyelids?
Thanks
Lars