Abstract
Purpose:
There is a lack of consistent prognostic data on the visual outcomes of patients with both open globe injuries and facial fractures. The Ocular Trauma Score (OTS) is a system that supplies patients with the likelihood of various visual acuity scores based on initial visual acuity, presence of rupture, endophthalmitis, perforating injury, retinal detachment, and RAPD. The purpose of this study is to assess the predictive value and applicability of OTS in high acuity patients with open globe injuries and facial fractures.
Methods:
Between January 1, 2000 and June 30, 2012, we identified 25 patients with 28 open globe injuries and facial fractures from the Elmhurst City Hospital Trauma Registry. A comprehensive retrospective chart review was done and statistical analysis was performed. The cutoff for p-value significance was less than 0.05.
Results:
Average age was 52 (range 18-88) and patients were predominantly male (84%). The majority of patients had an OTS of 1 (84%), and of these patients, 76.2% and 14.3% had final visual acuities of no light perception (NLP) and light perception/hand motion (LP/HM) respectively (p = 0.003). These corresponded to 74% and 15% predicted by the original OTS guidelines (100% sensitive and 100% specific). Independent of OTS score, initial visual acuity and frontal bone fractures were predictive of NLP (p = 0.006 and p = 0.047). Non-blindness was associated with nasal bone fractures (p = 0.047). Final visual outcome had no significant association with time to first surgical intervention (<24 hours or >24 hours). OTS score of 1 was associated with zone 3 eye wound location (p = 0.02), but was not associated with the presence of retinal detachment or vitreous hemorrhage at presentation, despite being one of the criteria included in calculating each score.
Conclusions:
This study validates the use of Ocular Trauma Scores in high acuity patients with combined facial fracture and open globe injury. In the absence of data to calculate a full OTS, initial visual acuity was the strongest predictor of final visual outcome. With regard to fracture type, frontal bone fracture was predictive of NLP, while nasal bone fracture was slightly protective in regard to final visual acuity. Time until surgical intervention was not predictive of visual outcomes in our cohort.