Purpose. To determine the best method in designing an easy-to-use OTS that would accurately and reliably predict functional outcome after a severe eye injury. Methods. Using several hundred cases of serious ocular trauma with final followup information from the United States and Hungarian Eye Injury Registries: clinicians' input and statistical analyses, two approaches were analyzed. Results. Clinicians ' input, based on literature review and personal experience, could not limit the variables to a manageable number, making OTS calculation too complicated. Also, some of the suggested diagnoses (e.g., globe perforation) are today not necessarily indicative of poor prognosis. Statistical analyses identified otherwise insignificant diagnoses (e.g., lacrimal laceration, orbital fracture). A combined approach (clinician input and statistical analysis) proved much more promising, identifying, among others, initial visual acuity, optic nerve injury (odds ratio [OR]: 10.3), hemorrhagic retinal detachment (OR: 4.8), endophthalmitis (OR: 4.8), corneoscleral rupture (OR: 2.5) as factors predictive of poor outcome. Conclusions. The OTS, by providing information on likely outcome early in the postinjury period, promises to be a helpful tool in clinical practice, research, rehabilitation, and in public health. Combining clinicians' input and statistical analyses appears to be the best method in developing the score.