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Heidi Eiseman, Michael E Rauser, Stephanie Terrill, So Eun Choi; Review of Ocular Findings in Patients With Orbital Wall Fractures: A 5 -Year Retrospective Analysis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2784.
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To determine the incidence of ocular injuries in patients with orbital wall fractures at Loma Linda University Medical Center, a level one trauma center. In a busy trauma center, understanding and quantifying patients who suffer globe trauma or ocular injuries with concomitant orbital fractures enables the Ophthalmology service to give the best and most efficient care in an emergency setting.
A retrospective study looking at patients from January 2008 to January 2013 diagnosed with orbital wall fracture secondary to blunt trauma. Patients not evaluated by the Ophthalmology service or those who had penetrating injuries were excluded. Patient data was collected including age, gender, mechanism of injury, visual acuity, type of orbital wall fracture, exam findings and imaging. Fractures were grouped as simple, comminuted and blowout.
A total of 621 charts were reviewed. Of those, 73.4% were male, 81.3% were Caucasian and 42.8% were between 18-40 years of age. Imaging was available in 582 patients for review. Fifty-nine percent of patients suffered a blowout fracture defined as a medial wall or floor fracture and no fracture of the zygoma or other walls, 34.5% suffered comminuted fractures and 6.1% suffered simple fractures. Seventy-two patients had bilateral orbital wall fractures (12.3%). The most common external exam finding was restriction of extraocular motility (32.5%). Subconjunctival hemorrhage (43.8%), pupil abnormalities (13.9%) and corneal abrasion (6.7%) were the most reported anterior segment injuries. Approximately 11% of patients had commotio retinae on posterior segment exam. Retinal hemorrhage was present only 2.8% of the time. Only five patients were found to have choroidal rupture (0.9%) and two presented with retinal tears (0.3%). Twenty-three patients were diagnosed with a ruptured globe (4.0%), 16 with a retrobulbar hemorrhage (2.8%) and 5 with entrapment (0.9%). One hundred and nine patients (18.7%) were taken for repair by facial trauma within 7 days of the injury and 83 (14.3%) had delayed repair greater than a week later.
Ocular motility and anterior segment abnormalities are commonly associated with orbital fractures. When concomitant globe rupture is absent, visually significant posterior segment abnormalities are rare.
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