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Juliana Gildener-Leapman, Anne Barmettler; The role of visual symptoms in predicting the presence and severity of ocular injury in orbital fractures. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6054.
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© ARVO (1962-2015); The Authors (2016-present)
Previous studies have evaluated the frequency of ocular injuries that occur with different types of orbital fractures, but there is a paucity of data regarding the relationship between patient reported visual symptoms and ocular injury in these traumas. This study was designed to assess the reliability of visual symptoms in determining the presence and severity of ocular injuries in the setting of orbital fractures.
This is an IRB approved retrospective chart review of patients with orbital fractures seen in five emergency departments in Bronx, New York over the past year. The following data was collected: patient demographics, visual symptoms, ophthalmologic exam, radiographic findings, along with medical and surgical interventions. Exclusion criteria included age under ten years, altered mental status, or insufficient data. Visual complaints were categorized into new-onset blurry vision, double vision, complete visual obstruction from edematous eyelid, and no visual complaints. The charts were then reviewed for ocular injuries and treatments in patients from each visual subset.
A total of 68 patients were evaluated for orbital fractures. Ophthalmology was consulted for 42 of these cases, among which were all 13 patients who reported visual symptoms. Patient subsets included 7 patients with blurry vision, 4 with diplopia, 2 with complete visual obstruction from eyelid edema, and 49 who denied visual symptoms. Patients sometimes had more than one ocular injury. Ocular injuries in those with visual symptoms were as follows: 1 corneal abrasion, 4 extraocular muscle restrictions, 2 iritis, 1 lens dislocation, 1 retrobulbar hematoma, and 1 retinal break. Ocular injuries in those without visual symptoms included: 1 iritis and 1 retrobulbar hematoma. No emergent ocular procedures were needed for patients who denied visual symptoms.
Prior studies have not looked at the relationship between patient reported visual symptoms and ocular injury. This study suggests that visual symptoms can be a useful predictor for the presence and severity of ocular injury in orbital fractures. This information may aid in the process of triaging patients for emergent ophthalmologic examination. As not all patients in this study were evaluated by ophthalmology, this may have resulted in an underdiagnosis of ocular injuries. Larger studies in the future could elucidate this further.
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